Shoulder Pain And Disability Index Research Articles

The Most Effective Corticosteroid Dose in the Treatment of Glenohumeral Osteoarthritis: Feasibility Pilot and Protocol for Double Blinded Randomized Controlled Trial

ObjectiveOsteoarthritis affects over 5.4 million people in the United States. A common treatment is to perform intra-articular corticosteroid injections. However, the ideal steroid dose is unknown. This study aimed to pilot a corticosteroid injection protocol for primary glenohumeral OA. MethodsWe conducted a double blinded randomized feasibility pilot study. Patients with primary osteoarthritis of the glenohumeral joint were recruited and randomized to receive 20 mg, 40 mg, or 80 mg of triamcinolone. The primary outcome was the feasibility of the protocol and change in the Shoulder Pain and Disability Index (SPADI) 6 months following injection. Results300 patients were screened for participation with 78 meeting inclusion criteria. 19 subjects completed the study. The most common reason for not participating was concern they would receive a smaller dose than previous injections. There was a 26% dropout rate, with 2 patients undergoing a total shoulder arthroplasty. There was no clinically significant difference (p=0.090) between the groups at 6-months for the SPADI although all treatment groups showed a reduction of SPADI from baseline at 6 months. There was one adverse event in the 20 mg group, with a patient experiencing facial flushing after the injection. ConclusionWe were successful in developing a feasible protocol. In the future excluding those who have received previous injections would be helpful for a higher enrollment rate. This patient concern highlights the need to complete clinical trials to guide medical decisions surrounding corticosteroid administration. NCT03586687

Anti-TNF (adalimumab) injection for the treatment of pain-predominant early-stage frozen shoulder: the Anti-Freaze-Feasibility randomised controlled trial

ObjectiveThe Anti-Freaze-F (AFF) trial assessed the feasibility of conducting a definitive trial to determine whether intra-articular injection of adalimumab can reduce pain and improve function in people with pain-predominant early-stage...

Adherence of individuals with shoulder pain to home exercise booklets: Barriers, facilitators, and the impact of disability, self-efficacy, and treatment expectations

Backgroundhome exercise booklets offer several benefits to individuals with shoulder pain. However, it is necessary to investigate the factors that determine adherence to home exercises. Objectives1) To investigate the level of adherence of individuals with chronic shoulder pain to a home exercise booklet conducted without the mediation of a healthcare professional, 2) To describe the barriers and facilitators to adherence, and 3) to determine if shoulder disability, self-efficacy, and treatment expectations are predictors of the level of adherence. Designprospective longitudinal study. MethodsA total of 47 individuals with chronic shoulder pain were recruited. The Numeric Pain Rating Scale (NPRS) was used to assess pain intensity, the Shoulder Pain and Disability Index (SPADI) to measure shoulder disability, the Pain Self-Efficacy Questionnaire (PSEQ-10) for self-efficacy, and a likert scale to measure treatment expectations. Adherence was measured by Exercise Adherence Assessment Scale (EAAE-Br). ResultsA total of 23 individuals (48.93%) adhered to the home exercise program. The most commonly cited barriers were pain and health-related issues, while the most cited facilitators were pain improvement and symptom relief. Barriers associated with adherence were time constraints and other commitments, while the facilitator associated with adherence was enjoying the exercises. Binary logistic regression analysis revealed that shoulder disability, self-efficacy, and treatment expectations were unable to predict adherence to home exercises in individuals with shoulder pain [F (1,47) = 2.384; p = 0.130; R2 = 0.056]. ConclusionThe study revealed barriers and facilitators to home exercise in individuals with shoulder pain. Disability, self-efficacy, and treatment expectations were not able to predict adherence.

Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial

ABSTRACT Purpose To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. Methods Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). Results After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). Conclusion Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.

Efficacy of pulsed radiofrequency on the suprascapular and axillary-circumflex nerve for shoulder pain: A randomised controlled trial

Background and Aims: Painful shoulder is one of the most frequent consultation causes. Multiple treatments have been described to relieve pain, restore range of motion and improve functionality. Methods: This randomised clinical trial was conducted in 60 patients. The treatment group received combined pulsed radiofrequency (PRF) on suprascapular nerve (SN) and axillary-circumflex nerve (ACN). The control group received PRF on SN only. The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS). The secondary outcomes were the Shoulder Pain and Disability Index (SPADI), the Constant–Murley range of motion scale and Disability of the Arm, Shoulder and Hand (DASH) scale. The patients were monitored at the baseline visit and at 1, 3, 6 and 9 months. A mixed ordinal regression model was estimated to evaluate the association between the study group and pain measured with NRS. Results: A global decrease in pain at the end of the study was noted. The global baseline NRS was 8.4, and the global final NRS at 9 months of follow-up was 6.2. Combined PRF on SN and ACN was not associated with lower NRS pain scores compared to single SN PRF [odds ratio (OR) =1.04, 95% confidence interval (CI) 0.91–1.20, P = 0.507]. Secondary outcomes showed no significant differences: SPADI (OR = 1.04, 95% CI 0.92–1.18), Constant–Murley (OR = 1.01, 95% CI 0.90–1.14), DASH (OR = 1.04, 95% CI 0.92–1.17). Conclusion: Combined PRF applied to SN and ACN was not superior to PRF applied to SN alone.

Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study

BackgroundFrozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients.PurposeThis study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients.MethodsOne hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach’s alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used.ResultsNo floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach’s alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met.ConclusionThe DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.

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.

Arthroscopic Bankart versus Open Latarjet; Short-to-Mid-Term Outcomes of Recurrence and Patient-Reported Outcomes in Patients with Recurrent Anterior Shoulder Dislocation

Objectives This retrospective comparative study compared the short to mid-term outcomes of arthroscopic Bankart repair and open Latarjet procedures in patients with recurrent anterior shoulder instability. Methods Patients who underwent either arthroscopic Bankart repair or open Latarjet procedures between 2008 and 2020, with at least one year of follow-up, were included. Arthroscopic Bankart repairs were performed on shoulders with minimal glenoid bone loss (&lt;15%), and the Latarjet procedure was performed if the preoperative computed tomography (CT) scan showed a 15% bone loss on the glenoid side or 30-40% humeral head bone loss. Their surgery results and patient-reported outcome measures (PROMs) were assessed using the Oxford Shoulder Score (OSS) and Shoulder Pain and Disability Index (SPADI). Results 133 patients were analyzed in Latarjet (n = 67) and Bankart groups (n = 66). Before surgery, the two groups of patients were similar regarding surgery side, hand dominance, education level, occupation difficulty level, and smoking (P&gt;0.05). However, Latarjet’s patients were younger (32 vs. 35, P=0.04), had a higher proportion of males (96% vs. 82%, P=0.01), and had a significantly shorter follow-up period (3.2 vs. 6.4 years, P&lt;0.001) than the Bankart group. There was no significant difference between the Latarjet and Bankart groups regarding the follow-up’s OSS score (37 vs. 36; P=0.94) and SPADI score (22 vs. 24, P=0.80). Dislocation was observed in only one patient (1.5%) in the Latarjet group (P=1.0). Subluxation was observed in 5 patients (7.5%) of the Latarjet group and three patients (4.5%) of the Bankart group (P=0.4). The overall instability rate was similar (P&gt;0.05). Conclusion Our findings suggest that both arthroscopic Bankart repair and open Latarjet are reliable techniques in short to mid-term follow-up based on the glenoid bone loss cut-off of 15%. Level of Evidence Therapeutic Level III

Effects of Yi Jin Bang versus conventional exercise therapy in people with subacromial pain syndrome: A randomized controlled trial

Background/objectivePrevious studies have indicated that mind-body exercises can reduce pain and improve function for patients with musculoskeletal conditions. Yi Jin Bang is a novel home-based Chinese mind-body Qigong exercise for shoulder pain. However, few studies have evaluated its effects on subacromial pain syndrome. This study aimed to compare the effects of Yi Jin Bang with conventional exercises for subacromial pain syndrome. MethodsAdults with subacromial pain syndrome (N = 105; mean [SD] age, 37 [16] years; 73 females [70%]; median [IQR] duration of symptoms, 12 [6–24] months) were randomly assigned to either the experimental group (n = 53) or the control group (n = 52). The experimental group performed home-based Yi Jin Bang exercises, whereas the control group performed home-based conventional exercises (stretching, strengthening, and motor control exercises). Both interventions were performed four times a week for 16 weeks. The primary outcome was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes included current shoulder pain intensity, active shoulder range of motion, back scratch test, isometric shoulder strength, and health-related quality of life. Assessments were performed at baseline and weeks 4, 8, 12, and 16. The primary endpoint was week 16. ResultsNo significant between-group difference was observed in the SPADI score at week 16 (mean difference, Yi Jin Bang minus conventional exercise, 0.14, 95% confidence interval −2.96 to 3.24; p = 0.93). ConclusionThere were no differences between Yi Jin Bang and conventional exercises in improving pain, disability, shoulder mobility, shoulder strength, and quality of life for people with subacromial pain syndrome.

The relationship between kinesiophobia, balance, and upper extremity functions in patients with painful shoulder pathology.

Poor balance ability may contribute to shoulder pathology in patients with existing shoulder pathologies or vice versa. The relationship between kinesiophobia and chronic shoulder pain intensity has been researched, although the conclusions are conflicting. To our knowledge, no study in the literature explores the association between kinesiophobia and balance in patients with shoulder pain. To investigate the relationship between kinesiophobia, upper extremity functions, and balance abilities in patients with shoulder pain. Cross-sectional observational study. Physical medicine and rehabilitation hospital. Not applicable. A total of 44 patients with shoulder pain were included in the study. The pain severity was assessed using a visual analog scale (VAS). The Tampa Scale for Kinesiophobia (TSK), Berg Balance Scale (BBS), and Shoulder Pain and Disability Index (SPADI) were used to assess the patients. Ultrasound was used to diagnose underlying shoulder joint problems. Static and dynamic postural control was evaluated. The most common pathologies detected by ultrasound were supraspinatus tendinitis/rupture (77.3%), cortical irregularity (68.2%), and bursitis (63.6%). TSK score did not correlate with age, body mass index, symptom duration, or VAS score in rest (all p > .05), but it was associated with scores on the BBS (r = -0.437, p = .003), SPADI-pain (r = 0.474, p = .001), SPADI-disability (r = 0.355, p = .018), SPADI-total (r = 0.405, p = .006), and VAS in activity (r = 0.331, p = .028). According to multiple linear regression analysis, BBS score, SPADI-total score, and anterior-posterior sway length were significant predictors of TSK (r = 0.645, r2  = 0.416). According to the findings of this study, the main risk factors for high levels of kinesiophobia are poor balance, severe pain, and disability. In addition to mechanical causes of shoulder pain, diagnosing and intervening on underlying balance issues and psychosocial causes of shoulder pain will improve treatment success.

Effects of proprioceptive neuromuscular facilitation technique on scapular dyskinesis in patients with subacute stroke

Objectives: The objective of this was to compare the effects of the proprioceptive neuromuscular facilitation (PNF) hold-relax technique on pain severity, range of motion (ROM) of the shoulder, shoulder disability, and scapular asymmetry in stroke patients with scapular dyskinesis. Methods: The study used a randomized clinical trial design including 46 patients ranging from 40 to 60 years with at least five months of stroke with type-1 scapular dyskinesia. The participants were divided into two groups, taking the upper limb Diagonal 1 (D1) flexion pattern and Diagonal 2 (D2) flexion pattern, respectively, which were allocated by consecutive sampling using the lottery method. We used a visual analog scale (VAS) for pain, goniometry for shoulder ROM, shoulder pain and disability index (SPADI) for shoulder disability, and lateral scapular slide test for scapular asymmetry. Results: D1 flexion and D2 flexion both improved the ROM in both groups (P &lt; 0.05) and decreased pain and disability, while in-between comparisons did not find a significant difference between the effectiveness of both treatments in terms of pain measured by VAS, ROM, that is, flexion, extension, and abduction (P &gt; 0.05). In terms of external and internal rotation, the D1 flexion pattern of PNF techniques showed more improvement as compared to D2 flexion (P &lt; 0.05). While in terms of SPADI, D2 flexion showed more improvement as compared to D1 flexion (P &lt; 0.05). Conclusion: Scapular PNF substantially influences stroke patients’ shoulder discomfort and ROM.

Impact of Virtual Rehabilitation in Adjunct to Conventional Physical Therapy on Proximal Humerus Fracture: A Randomized Controlled Trial.

Introduction Humerusfractures are fairly prevalent in the general population, and their incidence increases with age. The majority of minimally displaced fractures may be treated with prompt rehabilitation. An interdisciplinary team strategy involving experienced musculoskeletal specialists, geriatricians, and skilled physiotherapists should be employed for optimal therapy. Rehabilitation is essential in coping with the consequences of the fracture. The greatest current information for shoulder rehabilitation comprises the use of counseling, exercises, and mobility of restricted joints to regain upperlimbfunction. Virtual reality (VR) based therapies are among the most effective since they may give visual, aural, and somatosensory cues to help patients. In fact, VR-based treatments have been shown to enhance motor function, neuropathic pain, balance, and aerobic performance in individuals with neurological disorders. However, there is limited evidence on the use of VR's therapeutic efficacy on individuals with musculoskeletal disorders. This study applied oculus-guided VR rehabilitation in addition to conventional physical therapy for the rehabilitation of patients with proximal humerus fractures. This study aims to assess the impact of virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture. Methods This study is a randomized controlled trial in which 50 patients were divided randomly into two groups: 25 patients in group A and 25 patients in group B. Group A was an experimental group that received VR plus conventional therapy. At the same time, group B was a control group that received only conventional therapy. Shoulder range of motion (ROM), manual muscle testing (MMT), numerical pain rating scale (NPRS), disabilities of arm, shoulder, and hand (DASH), and Shoulder pain and disability index (SPADI) were used as outcome measures of this study. Results There is an increase in flexion (t=7.58, P=0.0001), extension (t=6.90, P=0.0001), abduction (t = 9.57, P=0.0001), internal rotation (t=6.31, P=0.0001), and external rotation (t=3.41, P=0.001) in group A is statistically more significant than group B. The improvement in MMT scores in group B (t=1.71, P=0.10) is not significant, whereas improvements in group A are statistically significant (t=13.86, P=0.0001). The SPADI and DASH scores improved more significantly in group A (t=62.46, P=0.0001, and t=57.48, P=0.0001, respectively) than in group B (t=39.14, P=0.0001 and 46.58, P=0.0001, respectively). There is no significant difference in pain outcomes between the two groups. Conclusion The findings of this study reveal that virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture is more effective in improving shoulder ROM, muscle strength, and upper limb function than conventional therapy alone.However, no intervention can be considered superior to others in terms of the management of pain associated with proximal humerus fracture.

Effects of humeral head stabilization intervention during aggressive manual passive stretching exercises in patients with painful stiff shoulder: A prospective, comparative study

BackgroundNo reports have been published verifying the effects of manual interventions such as humeral head stabilization on improving function and reducing pain when applying aggressive manual passive stretching in patients with painful stiff shoulders. The purpose of this study was to compare clinical outcomes, such as range of motion (ROM), pain, and disability scores, in patients with painful stiff shoulders with and without humeral head stabilization intervention while applying aggressive manual passive stretching. MethodsFifty-six patients with painful stiff shoulders were recruited (31 with humeral head stabilization intervention and 25 without such intervention). Clinical outcomes such as active ROM (A-ROM), pain, and disability scores were evaluated using a goniometer; measurement of activity visual analog scale (A-VAS); and disabilities of the arm, shoulder and hand (DASH) and shoulder pain and disability index (SPADI), respectively. ResultsAll the parameters, A-ROM, A-VAS, and disability scores (DASH and SPADI) were not significantly different between the two groups (p > 0.05) before the intervention. However, after the intervention, the mean difference in A-ROM for flexion, abduction, and external and internal rotation was 18 (95% confidence interval [CI], 14.1 to 21.7), 31 (95% CI, 24.9 to 37.4), 17 (95% CI, 13.4 to 21.4), and 16 (95% CI, 11.6 to 20.9), respectively. The mean difference in A-VAS and disability scores for DASH and SPADI was -1 (95% CI, -1.5 to -0.8), -27 (95% CI, 32.3 to -22.6), and -23 (95% CI, -27.8 to -18.3), respectively. All of these measurements favored humeral head stabilization. ConclusionDuring aggressive manual passive stretching in patients with painful stiff shoulders, humeral head stabilization intervention may be more beneficial in improving clinical outcomes such as A-ROM, A-VAS pain levels, and disability scores.

Scapulothoracic orientation has a significant influence on the clinical outcome after reverse total shoulder arthroplasty

BackgroundComputer simulation has indicated a significant effect of scapulothoracic orientation and posture on range of motion (ROM) after reverse total shoulder arthroplasty (RTSA). We analyzed this putative effect on the clinical and radiological outcome post-RTSA. MethodsWe retrospectively assessed 2-year follow-up data of RTSA patients treated at our clinic between 2008 and 2019. Patients were categorized into posture types A, B, and C based on an established method using scapular internal rotation on preoperative cross-sectional imaging. We compared differences in clinical ROM, pain, Subjective Shoulder Value, Constant Score, Shoulder Pain and Disability Index (SPADI), quality of life (EQ5D5L utility index) and radiological outcomes between posture types using linear regression analyses. ResultsOf 681 included patients, 225 had type A posture, 326 type B and 130 type C. Baseline group characteristics were comparable, although the type C group had a higher proportion of females (60% [A]; 64% [B]; 80% [C]) with lower abduction strength (0.7 kg [A]; 0.6 kg [B]; 0.3 kg [C]) and a slightly higher proportion with a Grammont design RTSA (41% [A]; 48% [B]; 54% [C]). There were significant adjusted differences in mean (±standard deviation) active flexion (A: 137±21°; B: 136±20°; C: 131±19°) and passive flexion (A: 140±19°; B: 138±19°; C: 134±18°), active (A: 127±26°; B: 125±26°; C: 117±27°) and passive abduction (A: 129±24°; B: 128±25°; C: 121±25°), SPADI (A: 81±18; B: 79±20; C: 73±23) and pain (A: 1.2±1.7; B: 1.6±2.2; C: 1.8±2.4) between posture types at 2 years (p≤0.035). A higher distalization shoulder angle was associated with better abduction in type C patients (p=0.016). Type C patients showed a trend towards a higher complication rate (3.9% vs 1.1% [A]; 3.2% [B]) (p=0.067). ConclusionsType C posture influences the 2-year clinical outcome of RTSA patients in terms of worse flexion, abduction, SPADI and pain. Scapulothoracic orientation and posture should be considered during the patient selection process, preoperative planning and implantation of a RTSA.

Integrating Physio-Yogic Exercises for Rotator Cuff Tendinopathy in Indian Overhead Athletes: A Comprehensive Approach.

Athletes affected by rotator cuff tendinopathy experience discomfort, stiffness, reduced range of motion, diminished athletic performance, and decreased quality of life. This study aimed to determine the efficacy of physio-yogic exercises in reducing pain and disability, increasing range of motion, and improving quality of life in Indian overhead athletes with rotator cuff tendinopathy. Sample from 45 athletes was divided into three groups scapular recruitment exercises, physio-yogic exercises, and yoga asanas. Pre-intervention readings of the Shoulder Pain and Disability Index (SPADI), Athlete Quality of Life Scale (ALQS), and Shoulder Active Range of Motion (AROM) were taken at day 1 and post-intervention readings were taken at the end of week 8. The paired Student's t-test was used to compare the values of the outcome measures for the preintervention and postintervention within the groups. Analysis of variance was used to compare the mean values of change in the outcome measures from preintervention to postintervention between the groups. Post hoc test was conducted to compare the postintervention values of the outcome measures between the groups. Total scores of SPADI (p < 0.0001), ALQS (p < 0.0001), and Shoulder AROM (p < 0.0001) demonstrated statistically significant improvements in the physio-yogic exercise group. The physio-yogic exercise protocol for rotator cuff tendinopathy is a unique regimen that combines the positive effects of yoga asanas and the advantages of scapular recruitment exercises. Thus, the physio-yogic exercise protocol can further promote the rehabilitation program for rotator cuff tendinopathy.

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&lt;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.

The Effect of Shoulder Pain on Sleep Quality

Objective: Shoulder pain, a common musculoskeletal issue, is most prevalent in patients aged 50-59. It can cause sleep problems, reducing sleep quality. We aimed to explore the relationship between sleep quality, pain, and disability in patients with shoulder pain, despite limited literature on this issue.&#x0D; Material-Method: Study involved 91 patients aged 18-80 with persistent shoulder pain sought out at a physical medicine and rehabilitation outpatient clinic. Factors such as age, gender, education, symptom duration, body mass index (BMI), occupation, and pain severity were recorded. Severity of pain was assessed using the visual analogue scale (VAS), pain and disability using the Shoulder Pain and Disability Index (SPADI), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI).&#x0D; Results: Average age was 54.9. 63% of patients were female and 28% were male. 14% of them had heavy work above shoulder level. A positive correlation was detected between PSQI and VAS and SPADI (p value 0.004 and 0.003, respectively). No significant relationship was found between PSQI and BMI and symptom duration (p value 0.464 and 0.718, respectively). While there was a significant difference in SPADI values between two groups with and without heavy work above the shoulder level, no significant difference was detected in PSQI values (p value 0.021 and 0.36, respectively).&#x0D; Conclusion: We found that the patient's VAS and SPADI values and sleep quality were negatively related to shoulder pain. Sleep disturbance due to pain at night can also affect daytime disability. Pain and sleep quality disorders can enter a vicious circle.

Correlation between Pain and Functional Disability in Patients with Adhesive Capsulitis

Background: Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and restricted shoulder movement, affecting daily activities and quality of life. Despite its prevalence, the correlation between pain levels and functional disability remains inadequately explored, with a need for focused research to inform clinical practices. Objective: To investigate the correlation between pain intensity and functional disability in patients with adhesive capsulitis and assess demographic characteristics to inform better management strategies. Methods: A cross-sectional study was conducted on 60 patients diagnosed with adhesive capsulitis at various medical institutions in Lahore from July 2022 to January 2023. Participants aged 31-70 years were included. The study employed non-probability convenience sampling for data collection, with pain intensity measured using the Numeric Pain Rating Scale (NPRS) and functional disability assessed through the Shoulder Pain and Disability Index (SPADI). Statistical analysis was performed using SPSS version 25.0, focusing on Pearson correlation coefficients to determine the relationship between pain and disability. Results: The majority of patients were females (68.3%), with a significant representation in the 41-50 year age group (31.7%). The mean pain intensity was 5.97 (SD = 0.88), and the mean SPADI score was 73.12 (SD = 10.37), indicating moderate to high levels of pain and disability. A strong positive correlation was observed between pain intensity and functional disability (Pearson correlation = 0.81, p &lt; 0.001), suggesting a direct relationship between the severity of pain and the extent of functional impairment. Conclusion: The study confirmed a significant positive correlation between pain and functional disability in patients with adhesive capsulitis, highlighting the impact of this condition on the affected population's functional capabilities. These findings emphasize the importance of comprehensive management strategies that address both pain and functional limitations to improve overall patient outcomes.

To allow or avoid pain during shoulder rehabilitation exercises for patients with chronic rotator cuff tendinopathy-Study protocol for a randomized controlled trial (the PASE trial)

BackgroundRotator cuff (RC) tendinopathy is the most reported shoulder disorder in the general population with highest prevalence in overhead athletes and adult working-age population. A growing body of evidence support exercise therapy as an effective intervention, but to date there are no prospective randomized controlled trials addressing pain as an intervention variable.MethodsA single-site, prospective, pragmatic, assessor-blinded randomized controlled superiority trial. Eighty-four patients aged 18–55 years with chronic (symptom duration over 3 months) RC tendinopathy are randomized 1:1 to receive shoulder exercise during which pain is either allowed or avoided. The intervention period lasts 26 weeks. During that period, participants in both groups are offered 8 individual on-site sessions with an assigned sports physiotherapist. Participants perform home exercises and are provided with a pain and exercise logbook and asked to report completed home-based exercise sessions and reasons for not completing sessions (pain or other reasons). Patients are also asked to report load and the number of sets and repetitions per sets for each exercise session. The logbooks are collected continuously throughout the intervention period. The primary and secondary outcomes are obtained at baseline, 6 weeks, 26 weeks, and 1 year after baseline. The primary outcome is patient-reported pain and disability using the Shoulder PAin and Disability Index (SPADI). Secondary outcomes are patient-reported pain and disability using Disability Arm Shoulder and Hand short-form (Quick DASH), and shoulder pain using Numeric Pain Rating Scale. Objective outcomes are shoulder range of motion, isometric shoulder muscle strength, pain sensitivity, working ability, and structural changes in the supraspinatus tendon and muscle using ultrasound.DiscussionThe results of this study will contribute knowledge about the treatment strategies for patients with RC tendinopathy and help physiotherapists in clinical decision-making. This is the first randomized controlled trial comparing the effects of allowing pain versus avoiding pain during shoulder exercises in patients with chronic RC tendinopathy. If tolerating pain during and after exercise proves to be effective, it will potentially expand our understanding of “exercising into pain” for this patient group, as there is currently no consensus.Trial registrationClinicalTrials.gov NCT05124769. Registered on August 11, 2021.

Acromioclavicular joint dislocation Rockwood type III and V show no difference in functional outcome and 91% recovered well without the need for surgery.

Acromioclavicular (AC) joint dislocations are common injuries, but the indication for and timing of surgery is debated. The objective of the study was to evaluate the results after acute AC joint dislocations Rockwood type III and V treated nonsurgically with the option of delayed surgical intervention. This is a prospective cohort study with clinical, radiological and patient-reported outcome assessment at baseline, 6 weeks, 3 months, 6 months and 1 year after acute AC joint dislocation. Patients aged 18-60 with acute AC joint dislocation and a baseline panorama (Zanca) radiograph with an increase in the coracoclavicular distance of >25% compared to the uninjured side were eligible for inclusion. All patients were treated nonsurgically with 3 months of home-based training and with the option of delayed surgical intervention. The primary outcome was the Western Ontario Shoulder Instability Index (WOSI). Secondary outcomes were surgery yes/no and the Shoulder Pain and Disability Index (SPADI). Ninety-five patients were included. Fifty-seven patients were Rockwood type III and 38 patients were type V. There were no statistically significant differences in WOSI and SPADI between patients with type III and V injuries at any time point. Nine patients (9.5%) were referred for surgery; seven type III and two type V (ns). Ninety-one percent of patients with acute AC joint dislocation Rockwood type III and V recovered without surgery and there were no differences in outcome scores between type III and V at any time point. Level IV.