Shoulder Disability Research Articles

Primary versus conversion reverse total shoulder arthroplasty for complex proximal humeral fractures in elderly patients: a retrospective comparative study.

The purpose of this study was to compare clinical, implant-related, and patient-reported outcomes of shoulders undergoing conversion to reverse total shoulder arthroplasty (rTSA) following previous open reduction-internal fixation vs. shoulders undergoing rTSA as a primary treatment modality for acute proximal humeral fractures (PHFs) in patients aged ≥65 years. We performed a retrospective analysis of a prospectively collected cohort of patients who underwent primary rTSA for PHFs vs. a cohort who underwent conversion arthroplasty with rTSA following fracture repair between 2009 and 2020. Outcomes were assessed preoperatively and at latest follow-up. Demographic characteristics and outcomes were analyzed between cohorts using conventional statistics, as well as stratification by minimal clinically important difference and substantial clinical benefit thresholds where applicable. In total, 406 patients met the study criteria, of whom 322 underwent primary rTSA for PHF and 84 underwent conversion rTSA after failed PHF open reduction-internal fixation. The conversion rTSA cohort was, on average, 7 years younger than the primary rTSA cohort (65±10 years vs. 72±9 years, P<.001). The follow-up periods were similar between the cohorts, with an average of 47.1 months (range, 24-138 months). The percentages of Neer 3-part (41.9% vs. 45.2%) and 4-part (49.1% vs. 46.4%) PHFs were similar (P>.99). The primary rTSA cohort achieved higher forward elevation, external rotation, and patient-reported outcome measurements including Simple Shoulder Test, American Shoulder and Elbow Surgeons, University of California-Los Angeles, Constant, Shoulder Arthroplasty Smart, and Shoulder Pain and Disability Index scores at a minimum of 24 months postoperatively (P<.05 for all). Patient satisfaction was higher in the primary rTSA group than in the conversion rTSA cohort (P=.002). Patient-reported outcome measures uniformly favored the primary rTSA cohort, rising to the level of statistical significance for forward elevation, American Shoulder and Elbow Surgeons score, and Shoulder Pain and Disability Index score (P<.05) relative to substantial clinical benefit. The adverse event rate and revision rate in the conversion rTSA cohort were higher than those in the primary rTSA cohort (26.2% vs. 2.5% [P<.001] and 8.3% vs. 1.6% [P=.001], respectively). At 10 years postoperatively, the revision-free implant survival rate was significantly lower in the conversion cohort compared with the primary cohort (66% vs. 94%, P=.012). Finally, the hazard ratio of revision was 3.69 in the conversion rTSA cohort compared with only 1.0 in the primary rTSA cohort. This study demonstrates that elderly patients who undergo rTSA as a conversion procedure following previous osteosynthesis do not fare as well as those treated with rTSA for acute displaced PHFs. Conversion rTSA patients report lower patient satisfaction and have significantly restricted range of shoulder motion, a higher risk of complications, a higher risk of revision, poorer patient-reported outcomes, and a shorter implant survival rate at 10 years compared with patients undergoing acute rTSA.

Comparison of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder.

Objective: To compare the outcome of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedic Surgery, Sahiwal Teaching Hospital Sahiwal. Period: February 2021 to January 2022. Material &amp; Methods: A total of 156 patients with refractory adhesive capsulitis were randomized. In Group-A, patients were treated with intra articular steroid injection alone and in Group-B, patients were treated with hydrodilatation using corticosteroid and saline. The patients were followed up at 3rd, 6th and 12th week and their functional outcomes was assessed in terms of pain and range of motion (disability) using “Shoulder Pain and Disability Index (SPADI)” scoring system. Results: In a total of 156 patients, 81 (51.9%) were females. The mean age was 51.4±10.6 years (ranged between 33 to 68 years). History of steroid intake was reported in 30 (19%) patients. The mean pain scores on the basis of SPADI scoring at 3-week (p=0.0001), 6-week (p=0.0001) and 12-week (p&lt;0.0001) were significantly less in Group-B when compared to Group-A. The disability scores on the basis of SPADI scoring at 3-week (p&lt;0.0001), 6-week (p&lt;0.0001) and 12-week (p&lt;0.0001) were significantly less in Group-B when compared to Group-A. In comparison to Group-A, functional outcomes were significantly better among patients of Group-B at 6-week (p&lt;0.0001) and 12-week (p&lt;0.0001) intervals. Conclusion: Hydrodilatation along with corticosteroid injection were better treatment options when compared to intra-articular steroid injection alone for reduction in pain and improvement in range of motion among patients with refractory frozen shoulder.

Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial

BACKGROUND: A diseased shoulder due to pain, stiffness, or weakness negatively affects patients’ quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES: The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN: The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING: Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the “clinical trials library for protocol registration and results system” with number NCT04724317. The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS: Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS: The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group. Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS: This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION: Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups. KEY WORDS: Adhesive capsulitis, pulsed radiofrequency, ozone, shoulder, glenohumeral joint, pain, hs-CRP, triamcinolone acetonide

Shoulder Pain and Trunk Muscles Endurance in Young Male and Female Swimmers.

Shoulder pain is a common syndrome in swimming and affects a large number of competitive swimmers. The purpose of the study was to investigate the relationship between pain in the shoulder girdle and the endurance of the trunk muscles in young swimmers. A total of 24 boys and 22 girls, aged 13 to 18 years, participated in the study. The measurements included the completion of a questionnaire (Shoulder Pain and Disability Index, SPADI) and a field test (McGill's Torso Muscular Endurance Test). The total SPADI score correlated weakly and negatively with the endurance time of back muscles in both sexes (r2 = 0.10, p = 0.035), and moderately and negatively in girls (r2 = 0.23, p = 0.023). A weak negative correlation was found between the disability index and the back muscles' endurance time in both sexes (r2 = 0.15, p = 0.007), which was moderate in girls only (r2 = 0.25, p = 0.019). The disability index displayed moderate negative correlations with the right oblique's (r2 = 0.18, p = 0.049) and left oblique's endurance time (r2 = 0.23, p = 0.024) in girls. Weight, body mass index, the total out-of-water training time per week and age significantly affected the endurance times of the trunk muscles in boys and girls (p < 0.05). In conclusion, strengthening the dorsal and the oblique muscles could reduce shoulder pain and disability in young swimmers and especially girls.

Effects of Muscle Energy Technique versus Shoulder Mobilization on Pain and Function in Patients with Subacromial Pain Syndrome

Abstract Background Subacromial pain syndrome is most leading cause of disability that includes the wide spectrum of disorders including subacromial tendinopathy, partial or full thickness tear of rotator cuff and subacromial bursitis. The manual therapy interventions for this condition are still debatable. Aim To evaluate the comparative effects of muscle energy technique (MET) versus posterior shoulder mobilization with movement (MWM) on pain, function and shoulder range of motion in patients with subacromial pain syndrome. Method Patients diagnosed with subacromial pain syndrome were recruited in this pragmatic parallel double blinded randomized clinical trial. The sample was selected through non-probability convenient sampling technique. Forty patients out of 56 meeting the eligibility criteria were equally divided into two groups, MET group (n = 20) and MWM group (n = 20), through a randomization web service. Data were collected at baseline and after successful completion of a six week trial treatment. Pain severity was measured by using a numeric pain rating scale, shoulder disability was measured by using the Shoulder Pain and Disability Index (SPADI) and ranges of motion were measured by using goniometry. Data was analyzed through SPSS 24. Results Outcome measures including pain, disability and shoulder range of motion were significantly (p ≤ 0.05) improved in both groups after the intervention. When comparing both groups, pain score was U = 82.0 (p ≤ 0.001) and disability score was t = –2.913 (p ≤ 0.006) favoring MET. Conclusion Both MET and MWM were effective for symptomatic management in this sample of 40 patients with subacromial impingement syndrome. MET seems to show some superior effects as compared to MWM.

Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis.

It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of 'shoulder', 'rotator', 'adhesive capsulitis', 'hydrodilatat*', 'distension' since inception of the databases to June 2023 was implemented. Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections. Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience. Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder. Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition.

Prevalence of Shoulder and Neck Pain Among Healthcare Workers in the Central Region of Saudi Arabia.

Introduction Musculoskeletal disorders (MSDs) have a tremendous impact on working people and are becoming a serious problem in the modern society. The healthcare system is regarded as having one of the most physically demanding jobs, and the risk of musculoskeletal injuries is high. Irrespective of their age, healthcare workers (HCWs) worldwide frequently experience shoulder and neck pain. In our study, we sought to understand what initiates shoulder and neck pain, such as stress or environmental factors, and what causes shoulder and neck discomfort among Saudi Arabian healthcare professionals. Methods A descriptive, cross-sectional study was conducted from 2022 to 2023, assessing shoulder and neck pain among healthcare workers in the central region of Saudi Arabia. An online survey was used, with 409 participants aged 20 or older. The questionnaire included socio-demographic data, Shoulder Pain and Disability Index (SPADI) questionnaire to measure shoulder pain and disability, neck Bournemouth questionnaire (NBQ) to assess neck pain, and quadruple visual analogue scale (QVAS) to measure the intensity of pain. Results Of the 409 HCWs, 56% were males, and 56.5% belonged to the age group of 20-30 years. The prevalence of high-intensity pain based on QVAS criteria was 29.3%. The mean percentage of neck pain (32.3%) was slightly higher than shoulder pain (31.8%). There was a significant association between the level of pain intensity in terms of the total score of NBQ, SPADI score, and its dimensions. It is interesting to know that HCWs with associated chronic diseases had higher scores in all three questionnaires (NBQ, SPADI, and QVAS). Conclusion High-intensity musculoskeletal pain was relatively high among HCWs. It was found that neck pain affected HCWs more than shoulder pain. Furthermore, an increased pain intensity in the shoulder and neck was more frequently seen in HCWs with chronic diseases. More studies are needed to determine the causes and risk factors for neck and shoulder pain to help improve the healthcare system and patient care.

Comparison of humeral head resurfacing versus stemless humeral components in anatomic total shoulder arthroplasty: a multicenter investigation with minimum 2-year follow-up

BackgroundThe purpose of this investigation was to compare minimum two-year outcomes of anatomic total shoulder arthroplasty (aTSA) performed with humeral head resurfacing (HHR) vs. stemless implants. MethodsA retrospective review of a large multicenter database was conducted. All patients who underwent aTSA with either HHR or stemless implants with minimum two-year follow-up were evaluated. Range of motion (ROM) and patient-reported outcomes (PROs) including Constant Score, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons score, University of California Los Angeles Shoulder Score, Shoulder Pain and Disability Index, and Shoulder Arthroplasty Smart score were collected for all patients presurgery and postsurgery. Radiographic data was collected to determine the presence of radiolucent lines as well as evaluate implant sizing and anatomic shoulder restoration. ResultsOverall, 127 patients were included with 49 patients receiving HHR and 78 stemless aTSA. Preoperatively, patients in the HHR group had worse ROM and PRO scores (P < .05). Although the stemless group had significantly greater active abduction (148 ± 28 vs. 116 ± 22, P < .001), forward flexion (154 ± 21 vs. 141 ± 15, P < .001) and external rotation (50 ± 16 vs. 34 ± 17, P < .001) and exhibited better scores on the SST (10.4 ± 2.0 vs. 9.5 ± 1.9, P = .014) at final postoperative evaluation, the HHR group had a greater improvement from preoperative to final postoperative evaluation in active forward flexion (50 ± 22 vs. 32 ± 20, P < .001) and internal rotation (3 ± 2 vs. 1 ± 2, P = .004) as well as all PROs measured (P < .01). Both groups demonstrated significant improvements in all PROs and ROM from presurgery to postsurgery (P < .05). Rates of overstuffing (8.7% in HHR vs. 20.8% stemless, P = .098), oversizing (39.1% in HHR vs. 31.3% in stemless, P = .436), and radiolucent lines around the glenoid components (13.0% in HHR vs. 18.8% in stemless, P = .450) were not significantly different between the groups. One patient in the stemless group required a revision surgery for aseptic glenoid loosening, otherwise no other major complications were reported. ConclusionaTSA performed both with stemless implants and HHR resulted in significant improvements in ROM and multiple PROs at minimum two-year follow-up with a low complication rate. The HHR group had worse preoperative shoulder function, which contributed to a greater magnitude of improvement in ROM and across all PROs from presurgery to postsurgery, despite the stemless group having better ROM and SST scores at final follow-up.

Comparison of the Effects of Conventional Physical Therapy Versus Progressive Overload Training in Patients with Shoulder Impingement Syndrome; A Randomised Clinical Trial

Abstract&#x0D; Background: Rotator cuff tendinitis and shoulder impingement are regarded as the frequent intrinsic reasons for shoulder discomfort and disability. &#x0D; Objective: A study was conducted to compare the effects of conventional physical therapy and progressive overload training in patients with shoulder impingement syndrome.&#x0D; Methods: Thirty patients with shoulder impingement syndrome were included. These patients were randomised into two groups. One group received structured, progressive resistance training, and the other received conventional therapy. The intervention group participants participated in progressive resistance training three days per week for six weeks. The numeric pain rating scale was used to assess pain intensity and the range of motion measured by the goniometer. The statistical package for social sciences (SPSS), version 21 for Windows, was used for data analysis. An independent t-test was used to compare the effects between the two&#x0D; groups. &#x0D; Result: Out of 30 participants, there were twenty-four females and six males. The mean age of the participants was 44±5.1 years. Participants from the intervention group had better pain control (P &lt; 0.05) and improved range of motion (P &lt; 0.05) compared to the control group. &#x0D; Conclusion: We conclude in this group of patients, progressive overload training was more effective in alleviating pain and improving the range of motion in patients with shoulder impingement syndrome.

The Addition of Exercise to High-Intensity Laser Therapy Improves Treatment Effectiveness on Pain and Muscle Strength in Patients with Subacromial Pain Syndrome: A Randomized Trial

Abstract Objective To assess the efficacy of adding exercise to high-intensity laser therapy (HILT) in improving treatment effectiveness for clinical outcomes in patients with subacromial pain syndrome. Methods Thirty patients with subacromial pain syndrome were randomly assigned to the HILT-only group (n=15) or HILT&amp;Exercise group (n=15). The primary outcome was shoulder function and disability. Secondary outcomes were pain, range of motion, proprioception (joint position sense), and muscle strength. Results Shoulder function and disability, pain, range of motion, joint position sense, and some muscle strength improved in both groups (p&lt;0.05). There was no significant time-group interaction for the Constant-Murley Score, Shoulder Pain and Disability Index, rest pain, range of motion, and joint position sense (p&gt;0.05). Time-group showed significant effects for activity pain and strength in favor of the HILT&amp;Exercise group. Middle trapezius, lower trapezius, and supraspinatus strength increased after HILT plus exercise (p&lt;0.05), activity pain, upper trapezius, serratus anterior, and subscapularis strength improved more compared to HILT (p&lt;0.05). Conclusions We found no clinically important differences between HILT and HILT-plus exercise in shoulder function and disability, rest pain, mobility, and proprioception, in patients with subacromial pain syndrome. The addition of exercise to HILT was superior to HILT for improving activity pain and muscle strength.

Efficacy of Low-level Laser Versus High-intensity Laser Therapy in the Management of Adhesive Capsulitis: A Randomized Clinical Trial.

Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments. To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC. Prospective, randomized, parallel group, patient- and assessor-blinded. A total of 45 patients (aged: 18-65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18-65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment. A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments. HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC. ClinicalTrials.gov Identifier: NCT05469672. None.

Poster 361: Prolotherapy in the Treatment of Sports-Related Tendinopathies: A Systematic Review

Objectives: Prolotherapy (PrT) involves the injection of a proliferant in order to irritate a microenvironment and promote healing via the inflammatory cascade. PrT has become an increasingly popular nonoperative treatment in orthopedics. However, numerous prolotherapy solutions exist and varying applications and results have been described. The purpose of this study is to review high-quality randomized controlled trials (RCTs) that analyzed efficacy and safety profiles of prolotherapy (PrT) treatments for the most common sports-related tendinopathies. Methods: All RCTs published in English between January 1st 1980 and July 30th 2021, reported in Embase, Medline, and Web of Science databases, were queried with search terms including sclerotherapy, prolotherapy, sports medicine, sports injuries, tendinopathies, and musculoskeletal pain/injuries. PRISMA guidelines were used. Studies analyzing tendinopathies using a RCT design were included, while case controls, reviews, and observational studies were excluded. Duplicates were eliminated through Endnote. The remaining articles were screened by titles, followed by abstract and then by full text analysis. The Cochrane collaboration tool was used to assess for risk of bias. Two researchers independently performed the screening and conflicts were resolved using Rayyan © software (Rayyan Systems Inc., Cambridge, MA, USA). Graphical representations were created using SPSS version 28.00. Results: Application of the inclusion and exclusion criteria yielded 20 RCTs (fig. 1): 6 studies on lateral epicondylitis (LE); 6 on rotator cuff tendinopathy (RC); 5 on plantar fasciitis (PF); 2 on Osgood-Schlatter disease (OSD); 1 on Achilles tendinosis. Most of the trials used dextrose injections over P2G or hypertonic glucose (fig. 2), and the most common studied conditions were LE and RC (fig.3). The average follow-up period was 12 weeks. No significant adverse effects were reported, and the most common outcome measures were visual analog scale (VAS), patient rated tennis elbow evaluation (PRTEE), quick- disabilities of the arm, shoulder, and hand (Q-DASH), and symptoms relief. For the treatment of LE, dextrose PrT was associated with significant improvement in VAS pain score at rest and PRTEE compared to normal saline (p&lt;0.041, p&lt;0.013 respectively). Additionally, compared to hyaluronic acid and lifestyle modifications, PrT showed significant improvement in VAS pain score with activity, Q-DASH, and PRTEE scores (p&lt;0.04, p&lt;0.04, p&lt;0.05 respectively). For the treatment of RC, dextrose PrT was found superior to physiotherapy in the shoulder disability index (p&lt;0.001). Finally, dextrose PrT demonstrated significant improvements in foot function index (p&lt;0.001) for the treatment of PF, and reduction of symptoms in OSD (p&lt;0.024) compared to physical therapy and lidocaine controls. Patients with AT had a more rapid improvement in symptoms in the combined PrT/eccentric loading exercises protocols compared to dextrose PrT alone (p&lt;0.007). A graphical representation of the results is reported in figure 4. Conclusions: This systematic review summarized high quality RCTs and found PrT injections to be overall safe and effective in the treatment of sports-related tendinopathies. Further RCTs with larger sample sizes and comparisons to orthobiologics would add to the literature. Based on the current findings, sports medicine professionals may safely pursue PrT as an additional component of conservative treatment before surgery.

Does Age Affect the Rate of Spinal Nerve Injury after Selective Neck Dissection? Age as a Prognostic Factor of Spinal Nerve Injury after Selective Neck Dissection.

The objective of this study is to investigate whether age is a significant risk factor for spinal nerve injury following selective neck dissection (SND) in patients with head and neck cancer. A retrospective cohort study was conducted on patients who had undergone SND for head and neck cancer at a tertiary hospital between 2020 and 2022. The primary outcome was the incidence of spinal nerve injury after SND. The secondary outcomes included the types and severity of spinal nerve injury and the impact of age on these outcomes. A total of 78 patients were included in the study and subdivided into two groups. Two shoulder-specific questionnaires (the Shoulder Pain and Disability Index (SPADI) and the Shoulder Disability Questionnaire (SDQ)) were administered to assess shoulder morbidity postoperatively. Twelve patients showed shoulder impairment following surgery. We divided the sample into two age-based groups; the older group showed a higher rate of SAN injury and the younger group showed a lower rate of improvement over time. This study suggests that age is a significant risk factor for spinal nerve injury following SND in patients with head and neck cancer. Older patients are more likely to experience spinal nerve injury after SND than younger patients. The findings of this study may help in the development of strategies to prevent spinal nerve injury in older patients undergoing SND for head and neck cancer.

The Effect of Central Sensitization on Shoulder Pain and Disability in Patients with Symptomatic Rotator Cuff Tear

Amaç: Rotator kaf (RK) yırtığı olan hastalarda santral sensitizasyon (SS) varlığı şimdiye kadar araştırılmamıştır. Bu çalışmada, semptomatik RK yırtığı olan hastalarda SS varlığının omuz ağrısı ve disabilite üzerine etkisini araştırmak amaçlanmıştır.&#x0D; Gereç ve Yöntem: Çalışmaya, kronik RK yırtığı olan 52 semptomatik hasta ve hastalar ile yaş/cinsiyet olarak eşleştirilmiş 35 sağlıklı kontrol dâhil edildi. SS varlığı ve şiddeti Santral Sensitizasyon Ölçeği (SSÖ) ile değerlendirildi. Ağrı duyarlılığı için lokal (etkilenen omuz) ve uzak (tibialis anterior) bölgelerden basınç-ağrı eşikleri (BAE) kaydedildi. Hasta grubunda ağrı ve disabilite, Vizüel Analog Skala (ağrı) ve Omuz Ağrı ve Disabilite İndeksi (OADİ) ile değerlendirildi. &#x0D; Bulgular: Hasta grubunun kontrol grubuna göre SSÖ skorları anlamlı yüksek (p &lt; 0,001) ve deltoidden ölçülen BAE değerleri anlamlı düşüktü (p = 0,040). SS (SSÖ skoru ≥ 40), hastaların 24 (%46,2)’ünde saptandı. SS’si olan hasta grubunda olmayanlara göre OADİ-ağrı skorları anlamlı yüksekti (p = 0,034). SSÖ skorları ile OADİ-ağrı skorları (r = 0,299) ve üst trapez (r = -0,302) ve deltoidden (r = -0,325) ölçülen BAE değerleri arasında orta derecede korelasyonlar saptandı (p &lt; 0,05). &#x0D; Sonuç: Bu çalışma, RK yırtığı olan hastaların yaklaşık yarısında SS olduğunu gösterdi. Buna karşın, lokal bölgeden (deltoid) ölçülen BAE değerinin sağlıklı kontrol grubundan anlamlı düşük bulunması sadece periferik sensitizasyon ile ilişkilendirilebilir. Ayrıca, RK yırtığına bağlı gelişen SS hastalarda disabiliteden ziyade artan ağrı yükü ile ilişkili gözükmektedir.

Short term effects of intraarticular triamcinolone acetonide injection on serum testosterone, luteinizing hormone, and follicle stimulating hormone levels in male veterans: A prospective pilot study.

Despite the common practice of intraarticular corticosteroid injections (ICSIs) for peripheral joint disease, little is known about their systemic effects on the hypothalamic-pituitary-gonadal axis. To assess the short-term effects of ICSIs on serum testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels together with changes in Shoulder Pain and Disability Index (SPADI) scores in a veteran population. Prospective pilot study. Outpatient musculoskeletal clinic. Thirty male veterans, median age 50 (range 30-69) years. Ultrasound-guided glenohumeral joint injection using 3 mL of 1% lidocaine HCl and 1 mL of 40 mg triamcinolone acetonide (Kenalog). Serum T, FSH, and LH levels, Quantitative Androgen Deficiency in the Aging Male (qADAM), and SPADI questionnaires at baseline, 1, and 4 week(s) post procedure. At 1 week post injection, serum T levels decreased by 56.8 ng/dL (95% confidence interval (CI): 91.8, 21.7, p = .002) compared with baseline. Between 1 and 4 weeks post injection, serum T levels increased by 63.9 ng/dL (95% CI: 26.5, 101.2, p = .001), recovering to near baseline levels. SPADI scores were reduced at 1 week (-18.3, 95% CI: -24.4, -12.1, p < .001) and 4 weeks (-14.5, 95% CI -21.1, -7.9, p < .001). A single ICSI can temporarily suppress the male gonadal axis. Future studies are needed to evaluate for long-term effects of multiple injections at a single setting and/or higher corticosteroid doses on male reproductive axis function.

Comparison of Kaltenborn mobilization technique and muscle energy technique on range of motion, pain and function in subjects with chronic shoulder adhesive capsulitis.

Shoulder adhesive capsulitis (AC) is a common musculoskeletal condition causing pain, loss of range of motion (ROM) in the shoulder, and a decrease in its functionality, yet poorly defined and understood since its identification. Kaltenborn mobilization technique (KMT) and muscle energy technique (MET) are commonly used physiotherapeutic techniques for their treatment. To the best of our understanding, there was no study found to compare the effectiveness of one technique over another. The objective of this study was to compare the effectiveness of KMT and MET on the ROM, pain and function in subjects with chronic shoulder AC. In this single-centred, single-blinded quasi-experimental study with a pretest-posttest design 35 subjects were randomized into two groups: Group A () received KMT and Group B () received MET along with the moist hot pack (MHP), supervised exercises and home exercises common to both the groups. A total of 32 subjects completed the study with three dropouts. Subjects were evaluated before and after 10 treatment sessions for the outcomes, shoulder external rotation passive range of motion (ER-PROM) and abduction passive range of motion (ABD-PROM) using the universal goniometer, intensity of pain using the numeric pain rating scale (NPRS) and functional disability using the shoulder pain and disability index (SPADI). Analysis of 32 subjects showed that both groups were homogenous at baseline. The within-group analysis showed significant improvement () in both groups related to all the outcomes. But when we compared the groups, Group B showed significant () improvement in NPRS and SPADI in comparison to Group A. However, there was non-significant () difference found in ER-PROM and ABD-PROM. Both KMT and MET are effective in improving ROM, pain and function but MET showed a significant reduction of pain and improvement in function in subjects with chronic shoulder AC, thus supporting its use as a physiotherapeutic treatment technique.

The effects of the mirror therapy on shoulder function in patients with breast cancer following surgery: a randomized controlled trial.

Shoulder dysfunction is one of the most bothersome questions for breast cancer survivors. Studies show that mirror therapy can improve shoulder function in patients with a limited shoulder range of motion and shoulder pain. Here, this article reports the results of a randomized controlled trial investigating the effects of the mirror therapy on shoulder function in patients with breast cancer following surgical treatments. Totally, 79 participants were divided to two groups receiving active range-of-motion upper limb exercise based on the mirror therapy or active range-of-motion upper limb exercise respectively for 8 weeks. Shoulder range of motion, Constant-Murley Score, Disabilities of Arm, Shoulder, and Hand Questionnaire, Tampa Scale of Kinesiophobia, Visual analog scale, and grip strength were measured at baseline (T0), 2 weeks (T1), 4 weeks (T2), and 8 weeks (T3). The effects of the intervention on shoulder function were analyzed in generalized estimation equation, from group, time, and the interactions between group and time based on the data from participants who completed at least one post-baseline observation RESULTS: At least one post-baseline observation was performed by 69 participants (n=34 mirror group, n=35 control group). 28(82.35%) participants in the mirror group adhered to the exercise compared to 30(85.71%) in the control group. Generalized estimation equation model showed group had main effects on forward flexion (Waldχ²=6.476, P=0.011), with the Cohen's d=0.54. The effects of the group on abduction, Constant-Murley Score, and Disabilities of Arm, Shoulder, and Hand Questionnaire were significant when fix the effects of the time. At 8 weeks, participants in the mirror group showed an improvement in abduction compared to the control group (P=0.005), the Cohen's d was 0.70. At 8 weeks, participants in the mirror group had a higher Constant-Murley Score than control group (P=0.009), with Cohen's effect size value of d=0.64. The mirror group showed a greater improvement on the Disability of Arm, Shoulder, and Hand Questionnaire than control group at 2 weeks, 4 weeks, and 8 weeks (P≤0.032), but with a weak effect size value of all (r≤0.32). Group had main effects on Tampa Scale of Kinesiophobia (Waldχ²=6.631, P=0.010), with the Cohen's effect size value of d=0.56. Mirror therapy improved shoulder flexion, abduction, shoulder function in daily life, and arm function and symptom of the affected shoulder in patients with breast cancer following surgical treatment, while decreasing fear of movement/(re)injury. Mirror configuration needs to be improved in further research to increase its feasibility. Breast cancer survivors can try mirror therapy as a practical and effective method in shoulder rehabilitation for a promotion on effects. ClinicalTrial.gov Identifier: ChiCTR2000033080.

Shoulder Proprioception and Its Correlation with Pain Intensity and Functional Disability in Individuals with Subacromial Impingement Syndrome-A Cross-Sectional Study.

Subacromial Impingement Syndrome (SAIS) is a common shoulder condition characterized by pain and functional impairment. Proprioception, the sense of joint position and movement, is crucial in maintaining joint stability and coordinating movements. The relationship between shoulder proprioception, pain intensity, and functional disability in individuals with SAIS remains unclear, with conflicting findings in the literature. This cross-sectional study aimed to evaluate shoulder proprioception, examine its correlation with pain intensity and functional disability, and contribute to our understanding of the clinical implications of proprioceptive deficits in individuals with SAIS. Forty-two individuals were diagnosed with SAIS, and an equal number of asymptomatic controls were recruited. Shoulder proprioception was assessed using a digital inclinometer, measuring joint position sense at various angles of flexion and rotation. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Shoulder Pain and Disability Index (SPADI). Results: Individuals with SAIS exhibited significantly higher joint position error (JPE) values compared to asymptomatic controls in all measured angles of flexion and rotation (p < 0.001). Strong positive correlations were observed between JPE and pain intensity (r = 0.61 to 0.71, p < 0.01) and disability (r = 0.56 to 0.68, p < 0.01). These findings suggest impaired shoulder proprioception is associated with higher pain intensity and functional disability in SAIS. This study provides evidence of impaired shoulder proprioception in individuals with SAIS and its correlation with pain intensity and functional disability. The results highlight the clinical relevance of proprioceptive deficits in SAIS and emphasize the importance of incorporating proprioceptive assessment and targeted rehabilitation interventions into managing this condition. Future research should focus on longitudinal studies with larger and more diverse samples to further understand the underlying mechanisms and evaluate the effectiveness of proprioceptive interventions in improving outcomes for individuals with SAIS.

Comparison of the efficacy of manual treatment according to fascial distortion model versus joint mobilization in patients with shoulder impingement: A randomized clinical trial

BackgroundThe Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, but to date no study has been conducted to compare its’ effect in comparison with joint mobilization on patients with shoulder impingement syndrome. ObjectiveThe present study aims to compare the efficacy of the FDM versus joint mobilization in pain intensity, pain-free abduction range of motion and function of patients with shoulder impingement syndrome. Designsingle-blind, parallel-arm randomized controlled trial. Methods26 patients diagnosed with shoulder impingement syndrome were equally randomized into 2 groups: manual treatment according to the FDM, and joint mobilization of the shoulder complex. All patients received 3 intervention sessions every other day. Pain intensity (by visual analogue scale), pain-free abduction range of motion (by goniometry) and function (by Persian version of shoulder pain and disability index) were measured before and after every session and at follow-up 2 weeks later. Patients’ satisfaction with treatment was also measured (by a 4-point Likert scale) at follow-up. ResultsFDM therapy group showed statistically significant greater pain reduction (P = 0.014) and range of motion increment (P = 0.044) than joint mobilization group after intervention, while only range of motion maintained the difference at follow-up (P = 0.034). Function improvement was not statistically different after the intervention (P = 0.582) and at follow-up (P = 0.094). There was no difference in patients’ satisfaction with treatment between groups (P > 0.05). ConclusionThe FDM is a safe and effective treatment approach with comparable results to joint mobilization in patients with shoulder impingement syndrome.

Characterizing the Myoarchitecture of the Supraspinatus and Infraspinatus Muscles With MRI Using Diffusion Tensor Imaging.

The societal cost of shoulder disabilities in our aging society keeps rising. Providing biomarkers of early changes in the microstructure of rotator cuff (RC) muscles might improve surgical planning. Elevation angle (E1A) and pennation angle (PA) assessed by ultrasound change with RC tears. Furthermore, ultrasounds lack repeatability. To propose a repeatable framework to quantify the myocyte angulation in RC muscles. Prospective. Six asymptomatic healthy volunteers (1 female aged 30 years; 5 males, mean age 35 years, range 25-49 years), who underwent three repositioned scanning sessions (10 minutes apart) of the right infraspinatus muscle (ISPM) and supraspinatus muscle (SSPM). 3-T, T1-weighted and diffusion tensor imaging (DTI; 12 gradient encoding directions, b-values of 500 and 800 s/mm2 ). Each voxel was binned in percentage of depth defined by the shortest distance in the antero-posterior direction (manual delineation), i.e. the radial axis. A second order polynomial fit for PA across the muscle depth was used, while E1A described a sigmoid across depth: . Repeatability was assessed with the nonparametric Wilcoxon's rank-sum test for paired comparisons across repeated scans in each volunteer for each anatomical muscle region and across repeated measures of the radial axis. A P-value <0.05 was considered statistically significant. In the ISPM, E1A was constantly negative, became helicoidal, then mainly positive across the antero-posterior depth, respective at the caudal, central and cranial regions. In the SSPM, posterior myocytes ran more parallel to the intramuscular tendon ( ), while anterior myocytes inserted with a pennation angle ( ). E1A and PA were repeatable in each volunteer (error < 10%). Intra-repeatability of the radial axis was achieved (error < 5%). ElA and PA in the proposed framework of the ISPM and SSPM are repeatable with DTI. Variations of myocyte angulation in the ISPM and SSPM can be quantified across volunteers. 2 TECHNICAL EFFICACY: Stage 2.