Shoulder Pain And Disability Index Disability Research Articles

Is the correlation of the core muscle performance with shoulder pain and function altered by scapular dyskinesis in subjects with shoulder pain?

BACKGROUND: Daily activities that involve upper limb movements require muscle activation from different body parts by transferring forces and energy along the functional kinetic chain. The scapulae connect and transfer forces between the trunk and the upper limbs, so scapular dyskinesis may compromise the performance of the kinetic chain. OBJECTIVE: To assess the relationship between core muscle performance and shoulder pain and function in individuals with shoulder pain, with and without scapular dyskinesis. METHODS: Data was collected from 77 non-athlete adults aged between 18 and 50 years with shoulder pain, 45 had scapular dyskinesis. Core muscle performance was measured using the prone bridging test (PBT). Shoulder pain and disability were measured by the Shoulder Pain and Disability Index (SPADI), and the upper limbs’ stability was assessed by the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The peak torque of shoulder external and internal rotators was measured using an isokinetic dynamometer. Multiple linear regression models evaluated the relationship between the PBT and CKCUEST, SPADI, and shoulder rotator strength. RESULTS: Significant correlations were found between the PBT and the SPADI total score (r = – 0.522), pain domain (r = – 0.513), and disability domain (r = – 0.501); normalized score (r = 0.593), and the power (r = 0.624) of the CKCUEST; and peak torque for external (r = 0.256) and internal (r = 0.292) rotations. Scapular dyskinesis did not influence the magnitude of the correlations and predictive values. CONCLUSION: The PBT was correlated with shoulder pain and function, but scapular dyskinesis did not affect the magnitude of these relationships.

Role of ultrasound guided suprascapular nerve block aided mobilization physiotherapy in frozen shoulder recovery: a prospective study

Background: Frozen shoulder is debilitating condition marked by progressive shoulder pain and restricted mobility, affecting sleep and activities of daily living of a person. The objective of this study was to evaluate the efficacy of USG guided suprascapular nerve block aided mobilization physiotherapy for management of frozen shoulder so as to improve the quality of living of patients. Methods: This prospective interventional study was conducted at the Department of Orthopaedics of a teaching institute of Central India from January 2021 to April 2023 after obtaining ethical clearance. Patients diagnosed with frozen shoulder and giving written consent were included in this study after considering the inclusion and exclusion criteria. Baseline demographics, symptom duration, degree of active and passive shoulder range of movement, Shoulder pain and disability index (SPADI) score were documented on day of presentation (preintervention) after which USG guided suprascapular nerve block was given. Post SSNB, 10 sessions of supervised mobilization physiotherapy was given. SPADI scores and degree of active and passive range of movement were noted at 3rd, 6th and 12th week and compared using statistical tests namely repeated measure ANOVA and chi square test of independence. Results: A total of 54 patients enrolled in the study after meeting inclusion criteria, only 46 completed the follow up and their mean SPADI pain score and mean SPADI disability score at presentation significantly reduced at 12 weeks post intervention. Range of flexion, abduction and external rotation of shoulder also showed significant increase (p value<0.05). Number of participants with severe restriction of shoulder internal rotation also decreased after SSNB aided physiotherapy. Conclusions: USG guided suprascapular nerve block aided physiotherapy exercise schedule is a safe and effective outpatient treatment for frozen shoulder providing early pain relief and improving shoulder mobility.

Shoulder Pain and Disability Scores and the Factors Influencing Them among Orthopedic Surgeons Working in the Kingdom of Saudi Arabia: A Cross-Sectional Study.

(1) Background: Musculoskeletal pain is common among orthopedic surgeons. Their common musculoskeletal issues include shoulder pain and disability. Many associated factors could lead to this pain and disability; by identifying these, we can prevent orthopedic surgeons' pain and improve their functional capacity. (2) Methods: This study aimed to gather quantitative data regarding the shoulder pain and disability experienced by orthopedic surgeons. It also aimed to explore the potential correlations between demographic characteristics and work-related factors and their pain and disability. This study interviewed 150 orthopedic surgeons working in the Kingdom of Saudi Arabia, asking questions on the Shoulder Pain and Disability Index (SPADI) scale and about their demographic characteristics. (3) Results: All interviewed orthopedic surgeons were male, married, and nonsmokers. Their SPADI pain subsection score was 25.24%, their SPADI disability subsection score was 21.25%, and their total SPADI score was 22.79%. Among the examined demographic characteristics, total SPADI scores have a significant positive correlation with body weight (Spearman's ρ = 0.432; p < 0.05) and body mass index (BMI; ρ = 0.349; p < 0.05). (4) Conclusions: Our findings indicate that all orthopedic surgeons generally suffer from moderate shoulder pain and disability. Body weight and body mass index are important factors that may influence shoulder pain and disability among orthopedic surgeons.

Low-level laser therapy versus ultrasound therapy combined with home-based exercise in patients with subacromial impingement syndrome: A randomized-controlled trial.

The aim of this study was to evaluate the effects of low-level laser therapy (LLLT) and therapeutic ultrasound (US) combined with home-based exercise (HBE) versus HBE alone in patients with subacromial impingement syndrome (SAIS). Between March 2021 and July 2021, a total of 60 patients with SAIS (19 males, 41 females; mean age: 51.3±10.4 years; range, 30 to 70 years) were included. The patients were randomly allocated to an LLLT group (LG), an US therapy group (UG), and a control group (CG). The LLLT and US therapy programs were applied five times a week, for a total of 15 sessions. Home-based exercise programs and cold-pack therapy were administered to patients in each group. The patients were evaluated at baseline and one and three months of follow-up using the Visual Analog Scale (VAS) for pain during activity, at rest, and at night, and the Shoulder Pain and Disability Index (SPADI). All groups showed a significant improvement in the VAS and SPADI scores after the first month (p<0.05). The VAS activity pain score (p=0.008), SPADI pain score (p=0.003), SPADI disability score (p=0.012), and SPADI total score (p=0.003) significantly decreased in the LG compared to the CG at one month of follow-up. However, there were no significant differences in the outcome measures among the three groups at three months (p>0.05). The LLLT combined with HBE is more effective than HBE program alone for relieving activity pain and improving shoulder functions in the short term. However, LLLT and US therapy do not provide additional effects in terms of pain and disability at three months.

IDF21-0561 Prevalence of shoulder musculoskeletal pain and disability in individuals with Diabetes Mellitus – a preliminary study

Background: In Chile, it is estimated that 9.8% of adult population have Diabetes Mellitus (DM). Beyond the most reported complications of DM, musculoskeletal disorders are commonly found, receiving relatively little attention from health professionals. The evidences shows that musculoskeletal injuries in individuals with DM may occur due to the hyperglycemia, generating an accumulation of the non-enzymatic advanced glycation end-products (AGEs), increasing collagen crosslinking, generating abnormal collagen deposit in tendons and ligaments, turning them thicker, rigid and weaker. The shoulder joint is frequently affected, presenting limited mobility and pain. Research in this area is scarce, perhaps because other complications have been considered more life threatening. However, musculoskeletal disorders can reduce physical mobility, representing a substantial burden on morbidity and quality of life. Aim: The purpose of this study is to estimate the prevalence of shoulder pain and the shoulder pain and disability index (SPADI) in individuals with type 2 DM from Talca city (Chile). Method: This study was approved by the ethical committee (218/2020). Adults with type 2 DM participated in the study. A survey was performed to identify the presence of shoulder pain. The SPADI questionnaire was applied to the symptomatic participants, to identify their pain and disability level, with scores varying from 0–100 (the higher the score, the greater the disability). Prevalence was calculated through percentage with the 95% CI. Chi-squared test was performed to obtain information regarding the association between presence of pain and sex. Results: A total of 75 DM type 2 individuals participated in this preliminary study (♀ = 39; ♂ = 36; 57.6 ± 9.9 years old). The prevalence of shoulder pain was 52%. Of those with shoulder pain, 25.3% were female and 26.7% male. From the total sample, the prevalence of shoulder pain in female was 48.7% and male 51.3%. However, no association was found between the presence of pain and sex (p=0.64). The SPADI questionnaire presented a pain dimension scored at 65.6% ± 21.2; and a disability dimension scored at 51.5% ± 25.1.Tabled 1DM type 2 subjectsPrevalence of shoulder pain % (95% CI)Total sample (n=75)52 (0.50-0.54)Female (n=39)48.7 (0.47-0.50)Male (n=36)51.3 (0.49-0.53) Open table in a new tab Discussion: High prevalence of shoulder pain was found in the study, contrasting with a similar study which found a prevalence of 25.7% of shoulder pain in DM Scottish subjects. Studies have found that prevalence of shoulder pain in general population varies from 6.9-26%, further highlighting the high prevalence in our study. Regarding sex prevalence, the presence of pain was not associated to sex, converging with the literature that shows no difference between sex in frozen shoulder patients with DM. For SPADI scores, results are similar to those observed in the literature in patients with DM, in which the SPADI pain score was 56.7% and SPADI disability 51%. With this study, we hope to elucidate the proportion of existing cases of shoulder pain in type 2 DM individuals in Chilean population. It will enable to analyze which factors are related to the presence of pain and dysfunction, guiding in the development of specific rehabilitation protocols.

Ultrasonography-guided hydrodissection using platelet-rich plasma or corticosteroid in adhesive capsulitis of the shoulder: A comparative study

Background: Adhesive capsulitis is a condition that presents with pain and progressive limitation of both active and passive shoulder movements. It can be primary or secondary, the latter includes causes such as rotator cuff tear, cardiovascular disease, and diabetes mellitus. The American Shoulder and Elbow Surgeons defines that adhesive capsulitis is a condition of uncertain ethology characterized by a significant restriction of both active and passive shoulder motions that occur in the absence of known intrinsic shoulder disorder. Commonly described as: Stage 1 – Freezing stage, with pain and stiffness lasting around 9 months. Stage 2 – Frozen stage, with persistent stiffness lasting 4–12 months. Stage 3 – Thawing stage, with spontaneous recovery lasting 12–42 months. Ultrasonography (USG)-guided hydrodissection is used for adhesive capsulitis of the shoulder due to its cost-effectiveness and acceptance among patients. As adhesive capsulitis is postulated as an i nflammatory and fibrotic disease, easy treatment with intra-articular corticosteroids (CSs) injection may reduce synovitis, limit the development of capsular fibrosis, and alter the natural history of disease. CS injections are effective for shorter duration, but newer agents such as platelet-rich plasma (PRP) are more effective with no serious side effects. Materials and Methods: In this study, 40 patients were taken of adhesive capsulitis of the shoulder and were divided randomly into two groups. One group received injection PRP and the other group received injection CS. The outcome was recorded. Results: There was a statistically significant reduction in numeric rating scale pain scores in both the groups over a time period of 6 weeks, but the PRP injection was observed to be better in reducing the pain scores when compared to the CS injection after the 6th week (P = 0.037). Initially, the CS injection performed better in the 1st week due to anti-inflammatory action. By the 3rd week, both the injections showed a similar effect. However, at the end of the study period (6 weeks), there was a better reduction in the Shoulder Pain and Disability Index (SPADI) pain scores (P = 0.0057) and SPADI disability scores (P = 0.029) of the group PRP. Conclusion: We concluded that USG-guided hydrodissection with PRP is more effective therapy than CS in terms of reduction of pain and improvement in shoulder function in the treatment of adhesive capsulitis of shoulder.

Hydraulic Distension with Pumping Technique for Treating Frozen Shoulder: A CaseControlled, Retrospective, Comparative Study with 6-Month Follow-Up

Background: We have applied a new method called “the pumping technique” to the capsulepreserving hydraulic distension for frozen shoulder. With this technique, the stretching effect can be directly applied to the joint capsule of the affected shoulder. Objectives: We attempted to evaluate the effect of capsule-preserving hydraulic distension using the pumping technique by comparing capsule-preserving hydraulic distension without it. Study Design: A case-controlled, retrospective, comparative study. Setting: Outpatient clinic of department of rehabilitation medicine in a single university hospital. Methods: Patients (n = 47) with frozen shoulder who were treated with hydraulic distension were assigned into the pumping group (n = 24) and the nonpumping group (n = 23). Range of motion (ROM), Shoulder Pain and Disability Index (SPADI), and Visual Analog Scale (VAS) scores were assessed. Results: Significant improvement of VAS, ROM, and SPADI scores was observed after the second injection in each group (P &lt; 0.05). There were significant differences in total passive ROM, abduction, and flexion after the fifth injection between the 2 groups (P &lt; 0.05). There was a significant difference in the disability domain of SPADI after the second injection between the 2 groups (P &lt; 0.05). However, there was no significant interaction between time and group with respect to VAS scores. There were no serious complications after procedures. Limitations: This was a retrospective study. There might be some limitations in gathering comprehensive records of outcome measurements. In addition, because the objective of this study was to determine the effect of the new pumping technique, included patients range was very narrow. This study only included patients who were treated 5 times with capsule-preserving hydraulic distensions with or without the pumping technique. Conclusions: Although the effect on pain was excellent in both groups, the superiority of the new pumping technique was demonstrated by reduction of SPADI disability subscale score and improvement of ROM of the shoulder compared with the nonpumping technique.

Cross-cultural adaptation and measurement properties of the Nepali version of the DASH (disability of arm, shoulder and hand) in patients with shoulder pain

BackgroundPatient-reported outcome measures (PROMs) are important tools in both clinical practice and research. However, no upper extremity PROM to assess physical disability is available in Nepali. The most commonly used and recommended questionnaire for the shoulder is the Disability of Arm, Shoulder and Hand (DASH). Therefore, the aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties.MethodsThe translation and cultural adaptation process followed international standard procedures. The translated Nepali version of the questionnaire (DASH-NP) was completed by 156 patients with shoulder pain from three Nepali hospitals at an initial assessment and by 121 at follow-up. A Nepali version of Global Rating of Change (GROC-NP) was completed at follow-up to dichotomise improved and stable participants. Measurement properties testing included: internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient, ICC), Minimal Detectable Change (MDC), construct validity - factor analysis, hypothesis testing with the Shoulder Pain and Disability Index (SPADI) (Pearson Correlation = r) and responsiveness - Area Under the Curve with minimal important change.ResultsSignificant adaptations such as changing measurement units, activities and terminology were incorporated to improve cultural relevance. Internal consistency (α = 0.92) and test-retest reliability (ICC = 0.97, 95% CI: 0.94–0.98, p < 0.001) were excellent. The MDC was 11 out of 100 points. There were moderate-high positive correlations with the SPADI pain and disability items (rs = 0.63 and 0.81, P < 0.001). Four factor solution was retrieved for the DASH-NP. The Area Under the Curve was 0.69 (95% CI: 0.57 - 0.81, p < 0.001) with minimal important change of 11.2/100 points.ConclusionsThe Nepali translation of the DASH is comprehensible, easy to administer via self-report or interview. It is found to be a reliable, valid, and responsive measure in patients with shoulder pain in Nepal. The DASH-NP can be used to assess shoulder pain related disability in Nepal for clinical practice or research.

Short term effect of yoga asana - An adjunct therapy to conventional treatment in frozen shoulder

BackgroundThe available treatments for frozen shoulder yield variable results. Physical therapy and analgesics are considered as the first-line treatment for this disorder, but the effects are not uniform. There is some evidence to support that alternative medicine may have a role in its management. Objective(s)This study was designed to examine the short-term effects of yoga therapy in patients with frozen shoulder of mild to moderate severity. Materials and methodsA prospective randomized controlled trial was conducted on patients with frozen shoulder between 30 and 60 years of age. They were divided into two groups: yoga (Y) and control (NY). A set of Asana exercises called “Standing Group of Asana” was practiced by the yoga group in addition to the conventional therapy as received by the control group. The patients were reviewed at 1, 2 and 4 weeks. The pain and functional assessment were done at baseline and at each review using the Shoulder Pain and Disability Index (SPADI). ResultsThere were 16 male and 20 female participants in the Y group, and 15 males and 21 females in the NY group. There was no statistically significant difference in age, sex, and pre-treatment SPADI score between the groups. At the end of the four weeks, the SPADI pain scores in the Y and NY group were 20.47 and 20.14, respectively (p = 0.666). The SPADI disability scores in the Y and NY group were 20.4 and 19.7, respectively (p = 0.599). Overall SPADI scores were 40.67 and 40.03 in the Y and NY group, respectively (p = 0.736). Both groups had a significant reduction in SPADI pain and disability scores. However, there was no significant difference between the groups in terms of SPADI scores. ConclusionThe effect of the Standing Group of Asana has no added advantage relative to standard frozen shoulder treatment when practiced for one month.

Comparison of outcome of ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: A randomized control trial

Background: Adhesive capsulitis (AC) is the most common cause of shoulder pain in India. There is little consensus regarding the optimal course of treatment for AC. The aim of the present study was to compare the effectiveness of ultrasound-guided suprascapular nerve block (USNB) with intra-articular steroid injection (IASI) in AC of shoulder in providing pain relief, functional improvement, and reduction of disabilities. Settings and Design: A prospective randomized control trial at a tertiary care hospital compared a single dose of IASI with USNB in patients having shoulder pain and stiffness secondary to AC of ≥12 weeks' duration, visiting Outpatient Department of Physical Medicine and Rehabilitation. Materials and Methods: Patients in the first group were given IASI (2 ml of 40 mg/ml triamcinolone) while in the other group received USNB (4 ml of 0.5% injection bupivacaine). Home-based therapeutic exercise program for AC was advised for both the groups. The outcome measures were the Shoulder Pain and Disability Index (SPADI) and passive range of motion (ROM) (flexion, abduction, and external rotation) of the affected shoulder. Follow-up was done at 1-week, 3-week, and 6-week time-points. Results: Both domains of SPADI (pain score and disability score) and passive shoulder ROM significantly improved (P 0.05). Conclusion: Suprascapular nerve block is comparable in efficacy to IASI in patient with AC.

PENATALAKSANAAN FISIOTERAPI KONDISI FROZEN SHOULDER e.c TENDINITIS MUSCLE ROTATOR CUFF DENGAN MODALITAS SHORT WAVE DIATHERMY, ACTIVE RESISTED EXERCISE DAN CODMAN PENDULAR EXERCISE

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Frozen shoulder is a pain in shoulders which conduces limitedness of shoulder joint motion. Tendinitis in M.Rotator Cuff, is an inflammation occured in muscle tendons fused in Rotator Cuff. Physiotherapy problematics of Frozen Shoulder are the existence of pain, the limitedness of joint motion, the decline of muscle strength, and the interference of functional activity. Physiotherapy examination includes examining pain with Verbal Descriptive Scale (VDS), examination of Limited Range Of Motion with Goneometer, examination of muscle strength with Manual Muscle Testing (MMT), and inspection of daily functional activities with the Shoulder Pain And Disability Index (SPADI) index. In this case, the chosen technology to resolve these problems are by using the modality of Short Wave Diathermy (SWD), Active Resisted Exercise and Codman Pendular Exercise.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To know the effect of Physiotherapy Management Frozen Shoulder e.c Tendinitis Muscle Rotator Cuff conditions with Short Wave Diathermy (SWD), Active Resisted Exercise and Codman Pendular Exercise.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This research was done in RSUD Kraton Pekalongan with analytic descriptive research design. Research subject in this Scientific Writing was a patient with Frozen Shoulder condition e.c. Tendinitis M.Rotator Cuff who was given physiotherapy interventions with the modality of Short Wave Diathermy (SWD), Active Resisted Exercise and Codman Pendular Exercise. Method of data collection and data analysis of this research were by using Autoanamnesis method. Research instruments consisted of the examination of pain, joint motion, muscle strength, and potentiality of functional activity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; After four times in therapy, the researcher got four result. They are there was a decline of force pain in T3 = 3 and motion pain in T2 = 2, there was an enhancement of joint motion in T3 and T4 in flexion movement, abduction, exorotation and endorotation of the left shoulder to active and passive movement, there was an enhancement of muscle strength in T3 = Muscle group exorotator and endorotator, and there was an enhancement of functional activity in T3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclution:&lt;/strong&gt; a physiotherapy intervention with device modality and therapeutic exercise modality of can help reduce the problems arising on the conditions of Frozen Shoulder.&lt;/p&gt;&lt;strong&gt;Keywords :&lt;/strong&gt; &lt;em&gt;Frozen Shoulder e.c Tendinitis M.Rotator Cuff, Short Wave Diathermy (SWD), Active &lt;/em&gt;&lt;em&gt;Resisted Exercise and Codman Pendular Exercise, Autoanamnesis Method, Indeks SPADI (Shoulder Pain And Disability Index)&lt;/em&gt;

Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction

ObjectivesThe purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. MethodsThis cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. ResultsRestriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P < .01), flexion ROM (r = 0.30, P < .05), abduction ROM (r = 0.39, P < .01), and external rotation ROM (r = 0.60, P < .01). Other variables were not significantly correlated with HBB ROM. Multiple linear regression analysis indicated that the variance in HBB ROM was explained by the SPADI disability subscore (P = .01) but not by visual analogue scale score (P = .05), FABQ score (P = .65), or duration of symptoms (P = .73). The FABQ score was not explained by limitation in HBB ROM and shoulder movements. ConclusionThese findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons.

Assessment and correlation of perceived harmfulness with psychological variables in patients with chronic shoulder pain

Background: Chronic pain can provoke emotional reactions, such as fear or even terror, depending on what we believe about the pain signals. Chronic pain can be difficult to treat, affecting the patients psychologically causing fear avoidance in them. Patients with chronic condition often suffer catastrophizing pain and perceived harmfulness. Thus, assessing perceived harmfulness in chronic shoulder pain is utmost important. Methods: Patients (N = 48) with chronic shoulder pain (duration more than 3 months) were enrolled for the study. They were administered Photograph series of daily activities-upper extremity (PHODA-UE-110), Tampa scale of kinesiophobia (TSK-11), Pain catastrophizing scale (PCS-4), Shoulder pain and disability index (SPADI). Their responses were statistically analyzed using Pearson's co-efficient. Results: The mean scores of the outcome studied were, PHODA-UE scores were 42 ± 8.43, 95% CI [40.41, 45.32], TSK scores were 28.77 ± 3.70, 95% CI [27.69, 29.84], PCS scores were 8.39 ± 2.54, 95% CI [7.65, 9.13], SPADI (Pain) scores were 81 ± 9.5, 95% CI [78.22, 13.32] and SPADI (Disability) scores were 79 ± 13.32, 95% CI [75.12, 82.87]. Following correlations were found to be significant: PHODA-UE with TSK (r = −0.32, p = 0.02, 95% CI [−0.56, −0.04]), PHODA-UE with PCS (r = −0.49, p = <0.0003, 95% CI [−0.68, 0.24]), TSK with SPADI (Disability) (r = −0.41, p = 0.003, 95% CI [−0.62, 0.15]) and TSK with PCS (r = +0.40, p = 0.004, 95% CI [0.13, 0.61]). Conclusions: The present study reveals that the patients evaluated demonstrated low perceived harmfulness in spite of the chronic pain. Correlations between perceived harmfulness and psychological variables showed weak correlations.

Effectiveness of High-Intensity Laser Therapy in Subacromial Impingement Syndrome.

The short-term effectiveness of high-intensity laser therapy (HILT) was investigated as a retrospective case series for the treatment of the pain and disability associated with subacromial impingement syndrome (SAIS). A total of 42 patients, who were diagnosed with subacromial impingement syndrome, underwent a total of nine sessions (three sessions per week) of high-intensity laser therapy. The patients were evaluated before therapy and 8 weeks after therapy using the pain and disability subscales and the total scores of the Shoulder Pain and Disability Index (SPADI), as well as scores for the University of California at Los Angeles (UCLA) shoulder rating scale. Significant differences were observed between SPADI pain, disability, and total scores and UCLA scores of the patients. HILT was found to be effective in the short term in the treatment of pain and disability in patients with SAIS.

Structural Characteristics Are Not Associated With Pain and Function in Rotator Cuff Tears: The ROW Cohort Study.

Background:Structural characteristics of rotator cuff tears are used in surgical decision making. However, data on the association of tear size with patient-reported pain and function are sparse.Purpose:To assess the association of tear size, fatty infiltration, and muscle atrophy with shoulder pain/function in patients with cuff tears undergoing operative and nonoperative treatment.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 67 patients with rotator cuff tears were recruited for this longitudinal cohort study. Patients were determined to have a cuff tear using clinical assessment and blinded magnetic resonance imaging review. The Shoulder Pain and Disability Index (SPADI) was used as a measure of shoulder pain and function.Results:Tear size and thickness were not significantly associated with pain (SPADI pain score, 60.6 [95% CI, 49.8-71.5] for partial-thickness tear; 56.8 [95% CI, 42.8-70.7] for <2 cm full-thickness tear; 60.4 [95% CI, 51.7-69.0] for ≥2 cm full-thickness tear). Tear size and thickness were not associated with function (SPADI disability score, 42.7 [95% CI, 29.8-55.6] for partial-thickness tear; 37.6 [95% CI, 23.9-51.4] for <2 cm full-thickness tear; 45.1 [95% CI, 35.4-54.8] for ≥2 cm full-thickness tear). Fatty infiltration, muscle atrophy, and tendon retraction were also not significantly associated with SPADI pain and disability scores. A Mental Health Index score of <68 as well as age ≥60 years were significantly associated with a higher SPADI pain score. Female sex, increased number of comorbidities, Mental Health Index score of <68, and age <60 years were significantly associated with a higher SPADI disability score.Conclusion:In patients with rotator cuff tears undergoing operative and nonoperative treatment, pain and functional status were not associated with tear size and thickness, fatty infiltration, and muscle atrophy. Conversely, factors unrelated to cuff anatomy such as mental health, comorbidities, age, and sex were associated with pain/function. These findings have clinical implications during surgical decision making and suggest that pain and functional disability in patients with rotator cuff tears is multifactorial and should not solely be attributed to structural characteristics.

Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms

BackgroundThe Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that aims to measure pain and disability associated with shoulder disease. The aim of the present study was to investigate the construct validity and factor structure of the SPADI in a population-based study of patients with self-reported chronic shoulder symptoms.MethodsThe North West Adelaide Health Study is a representative longitudinal cohort study of people aged 18 years and over. The original sample was randomly selected and recruited by telephone interview. Overall, 3 206 participants returned to the clinic during the second stage (2004-2006) and were asked to report whether they had pain, aching or stiffness on most days in either of their shoulders. Data was also collected on body mass index and shoulder range of motion (ROM) and demographic factors. The SPADI (numeric rating scale) was administered to participants with shoulder symptoms. Principal components factor analysis, with varimax rotation of factor loadings, was used to assess subscale structure of SPADI. Correlations between the SPADI, shoulder ROM and SF-36 were performed.ResultsOverall, 22.3% of participants indicated that they had pain, aching or stiffness in either of their shoulders. SPADI results were available for 588 of participants with current shoulder symptoms. The internal consistency of the SPADI subscales were high (Cronbach's alpha > 0.92). Two factors, explaining 61.4% of the total variance were extracted by factor analysis. These were interpreted as disability and pain respectively. There was a strong negative correlation between SPADI disability subscale scores and shoulder range of motion. SPADI disability, but not pain, subscale scores were correlated with age.ConclusionsThe SPADI is a valid measure to assess pain and disability in people with shoulder pain in a population-based study. In this setting, the SPADI had a bidimensional structure with both pain and disability subscales.

Psychometric Properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients With Shoulder Pain

Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain. Objective To investigate the reliability and validity of 2 commonly used measures of pain related fear in patients with shoulder pain. Design A preplanned secondary analysis of a prospective single-arm trial involving a repeated-measures design. Setting Outpatient physical therapy clinics. Participants Patients (N=80) with a primary report of shoulder pain. Intervention All patients completed the outcome measures at baseline and at follow-up. Main Outcome Measures Patients completed a modified Fear-Avoidance Beliefs Questionnaire (FABQ), the 11-item version of Tampa Scale of Kinesiophobia (TSK-11), and the Shoulder Pain and Disability Index (SPADI) at baseline and at a 48-hour follow-up. Patients were dichotomized as improved or stable at follow-up based on the Global Rating of Change. Results Factor analysis indicated 3 stable factors for the FABQ and 1 stable factor for the TSK-11. Shoulder specific scoring for the FABQ and TSK-11 were used in subsequent analyses. Test-retest reliability intraclass correlation coefficient (ICC) was substantial for the FABQ and the TSK-11. The FABQ correlated significantly with SPADI pain and disability scores, while the TSK-11 correlated significantly only with SPADI pain scores. The shoulder-specific FABQ–W (work beliefs subscale) was a better than chance predictor of missing days of work during the 48-hour study period. Conclusions The modified FABQ and TSK-11 may be appropriate for use in patients with shoulder pain. Shoulder-specific scoring of these measures resulted in substantial test-retest reliability, and the FABQ correlated with the SPADI for pain and disability. The FABQ also showed potential for prediction of short-term work loss in this sample. Pain-related fear may be an important variable in patients with shoulder pain and merits future consideration in longitudinal studies.

Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial

We compared the short-term efficacy and safety of intra-articular (IA) botulinum toxin A (BoNT/A) to IA-placebo in patients with chronic, refractory shoulder joint pain. Forty-three shoulder joints in patients with moderate-to-severe shoulder arthritis pain were randomized to receive (1) 100 units IA-BoNT/A + lidocaine or (2) IA-saline + lidocaine. The following outcomes were compared using analysis of covariance: (1) primary: change in pain severity on a visual analog scale at 1 month (VAS, 0 cm to 10 cm); (2) secondary: Shoulder Pain and Disability Index (SPADI) disability subscale, quality of life on short-form (SF)-36 subscales, percent of patients who achieved at least a 30% decrease or a 2-point reduction in VAS pain (clinically meaningful pain relief), and safety. Both BoNT/A (n = 21) and placebo (n = 22) groups were comparable at baseline. At 1 month post-injection, the VAS pain reduction was significantly more in the BoNT/A group versus the placebo group (-2.4 vs -0.8; P-value = 0.014). When comparing BoNT/A with the placebo group at 1 month, it was observed that 5 SF-36 subscale scores improved significantly (P </= 0.035), and the SPADI disability improved more with a trend toward significance (51.5 +/- 4.4 vs 64.9 +/- 3.9; P = 0.083). In addition, clinically meaningful pain relief occurred in 61% versus 36% patients (P = 0.22). The total number of adverse events was similar, which included 50 events in the BoNT/A group versus 46 events in the placebo group. A single injection of BoNT/A produced statistically significant and clinically meaningful pain relief and improvement in quality of life in patients with chronic refractory moderate/severe shoulder arthritis pain at 1 month. These data provide evidence to support the efficacy of this novel neurotoxin therapy that needs to be confirmed in a multicenter, randomized trial.

Is Diabetes Associated with Shoulder Pain or Stiffness? Results from a Population Based Study

To assess the association of shoulder pain and/or stiffness and diabetes mellitus in a population based cohort. Participants were randomly recruited from the North West Adelaide Health Study, a longitudinal, population based study. In the second stage, 3128 participants were assessed for diabetes mellitus and shoulder complaints via questionnaires, the Shoulder Pain and Disability Index (SPADI), physical assessment, blood sampling for fasting plasma glucose, and HbA1c levels. Overall, 682 (21.8%) participants experienced shoulder pain and/or stiffness and 221 participants (7.1%) fulfilled criteria for diabetes mellitus. Those with diabetes had a higher prevalence of shoulder pain and/or stiffness (27.9% vs 21.3%; p = 0.025), and poorer SPADI disability subscore (p = 0.01) and total SPADI score (p = 0.02). After controlling for age, sex, obesity, and current smoking, the prevalence of shoulder pain and/or stiffness did not differ significantly between those with diabetes and those without (OR 1.05, 95% CI 0.76-1.45), nor were there significant differences in the SPADI disability subscore (p = 0.39) or total SPADI score (p = 0.32) between the 2 groups. After adjustment for covariates, there was no association between higher levels of HbA1c and shoulder pain and/or stiffness (p > 0.8). Range of shoulder movement was significantly reduced in those with diabetes (p < 0.05). There is a higher prevalence of shoulder pain and/or stiffness in people with diabetes mellitus. The differences observed between those with diabetes and those without can largely be explained by the confounding factors of age, sex, obesity, and current smoking.

Assessment of shoulder involvement and disability in patients with ankylosing spondylitis

The purpose of the study was to evaluate the parameters which have an important role in shoulder involvement and disability in ankylosing spondylitis (AS). Ninety patients with AS were divided into two groups according to the presence of shoulder involvement. Bath AS metrology index (BASMI), ankylosing spondylitis quality of life (ASQoL) and shoulder pain and disability index (SPADI) were used. Ranges of movements of limited shoulders were measured. Mean disease duration, age, BASMI, and ASQoL were higher and hip involvement was more frequent in the shoulder-involved group. Disease duration was found to be the most significant factor in shoulder involvement. A significant relationship was found between all SPADI scores and ASQoL. The SPADI disability score was affected by flexion limitation. Patients with hip involvement and longer disease duration should be evaluated for shoulder involvement. Flexion limitation of shoulder affected shoulder disability and shoulder disability impaired quality of life.