Shoulder Pain Research Articles

Quantitative Structure-activity Relationship (QSAR) Modelling of Indomethacin Derivatives using Regression Analysis.

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) used for medication to reduce fever, spondylitis, or shoulder pain. It mainly works by the inhibition of prostaglandins, the endogenous signaling molecules. Fifteen indomethacin derivatives have been analyzed in relation to their physicochemical and molecular properties. Two-dimensional (2D) structures of fifteen indomethacin derivatives were drawn using the ACD Lab Chem Sketch version. Most of the topological parameters, such as wiener index (W), mean wiener index (Wa), Balaban indices (J), Balaban centric index (BAC), and molecular connectivity (χ), were calculated by using E Dragon software. The most common molecular file formats accepted in EDragon software were SMILES notations created online by Babel software and 2D structures of various derivatives, which were converted into 3D optimized structures using online CORINA, provided by Molecular Networks GMBH. 3D structures of compounds were also drawn on Gauss View software for calculations of various density functional theory (DFT) based quantum chemical descriptors, such as total energy (TE), softness (S), hardness (η), chemical potential (μ), highest occupied molecular orbital energy (HOMO), and lowest unoccupied molecular orbital energy (LUMO). All species were fully optimized in the gas phase with a 6-31+G* basis set. The harmonic vibrational frequency calculations were used to confirm that the optimized structures were minima, as characterized by positive vibrational frequencies. Combinations of various descriptors, such as D, ID, IOR, Log P, Mr, Mv, Mw, Pc, BAC, Pz, St, W, Wa, 0χ, 1χ, 2χ,3χ,4χ, 5χ, and Xeq have been found to be significant for modeling of activity. QSAR model no. 2: pIC50= -20.605 (±6.600) IOR - 0.747 (±0.454) I1 -5.083 (±3.478) Xeq + 51.647 optimized with empirical parameters with high statistical quality (R= 0.921, R2=0.848) was found to be the best model obtained. The QSAR model obtained suggests that substituents with a lesser value of the index of refraction and less electronegative groups were favourable for the activity, whereas indomethacin derivatives with a CH2CH2NHCONH(CH2)3ONO2 group at R1 position were unfavourable for the activity. The results were critically discussed based on regression data and cross-validation techniques. Pogliani factor Q and the results of the LOO (leave-one-out) method confirmed the reliability and predictability of the proposed models that could be highly beneficial for the future designing of new analogues with higher potency.

Machine learning insights into scapular stabilization for alleviating shoulder pain in college students

Abstract Non-specific shoulder pain is a common musculoskeletal condition, especially among college students, and it can have a negative impact on the patient’s life. Therapists have used scapular stabilization exercises (SSE) to enhance scapular control and mobility. This study investigates the prediction of the impact of scapular stability exercises in treating non-specific shoulder pain, leveraging advanced machine learning techniques for comprehensive evaluation and analysis. Using a diverse range of regression models, including Gamma Regressor, Tweedie Regressor, Poisson Regressor, and others, the study examines the relationship between the effectiveness of various exercises and their impact on shoulder pain management. Furthermore, the study employs optimization techniques, such as Hyperopt, scikit-optimize, optunity, GPyOpt, and Optuna, to fine-tune the exercise protocols for optimal outcomes. The results reveal that scapular stabilization exercises, when optimized using machine learning algorithms, significantly contribute to reducing shoulder pain in college students. Among the optimization techniques, scikit-optimize demonstrated the best performance, resulting in a mean squared error of 0.0085, a mean absolute error of 0.0712, and an impressive R2 score of 0.8501. This indicates that the scikit-optimize approach yielded the most accurate predictions and effectively captured the relationship between the exercises and shoulder pain management. The findings highlight the critical role of scapular stabilization exercise interventions in ameliorating non-specific shoulder pain and underscore the potential of machine learning techniques in optimizing therapeutic strategies for musculoskeletal health management. The utilization of scikit-optimize, in particular, showcases its effectiveness in fine-tuning the exercise protocols for optimal outcomes. The study’s results serve as a crucial stepping stone in developing personalized rehabilitation programs for non-specific shoulder pain, emphasizing the importance of integrating machine learning methodologies in the assessment and treatment of musculoskeletal disorders among college students.

Factors Influencing Outcome After Shoulder Arthroplasty (FINOSA Study): Protocol of a Prospective Longitudinal Study With Randomized Group Allocation

Background There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. Objective This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. Methods To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Results Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Conclusions Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. Trial Registration ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267 International Registered Report Identifier (IRRID) DERR1-10.2196/56522

A COMPARATIVE STUDY BETWEEN DRY NEEDLING AND KINETIC CHAIN ACTIVATION TECHNIQUE WITH SPECIFIED EXERCISE PROGRAMME IN PAINFUL ARC SYNDROME

Objective: Many researcher have reported that painful arc syndrome arises from multiple lesion i. e. minor tear of supraspinatus tendon, supraspinatus tendinitis, calcified deposit in the supraspinatus tendon, subacromial bursitis, crack fracture of greater tuberosity of humerus and bicipital tenosynovitis. In this study, dry needling and KCAT technique with specific exercise programme has been done to reduce pain and improve functioning and their by prevent shoulder pathologies. The objective of the study is. 1) To evaluate the effectiveness of kinetic chain activation in painful arc syndrome. 2) To evaluate the effectiveness of dry needling therapy in painful arc syndrome. 3) To evaluate the effectiveness of a specific exercise program. Methods: 50 patient diagnosed with painful arc syndrome by the physiotherapy department orthopedic department OPD will be initially assessed for the inclusion or exclusion criteria. prior to the treatment procedure patients are oriented to the study and taken informed consent, patient is divided in to two groups(Group A and Group B) and both groups will be assessed for the pre-test parameter. Outcome measure – shoulder pain and disability scale and goniometry is used for measuring pre-test and post-test. Results: The study was significant in reducing pain level and improving function with the pretest. At the end of 6 w treatment program with, both group A (dry needling) and group B(KCAT) showed improvement in painful arc syndrome. Based on results, the study supports research hypothesis that there was a significant improvement in ROM and significant reduction in SPADI score associated with painful arc syndrome. Patient participated in group B shows more significant changes. Conclusion: The study showed that significant improvement in symptoms of group B as compared to group A from the initial level to week 6. At the end of 6 w training programme both group A and group B Shows improvements in symptoms but the result of study supports that group B (KCAT CONCEPT-finger fanning technique) B is more efficient compare to group A(dry needling).

A bird-eye view of diaphragmatic endometriosis: current practices and future perspectives

Diaphragmatic endometriosis is one of the most common localization of extra-pelvic endometriosis and may cause debilitating symptoms such as cyclic shoulder pain, right upper abdominal pain, and right-sided chest pain. Diaphragmatic endometriosis may also be asymptomatic. The exact mechanisms by which diaphragmatic endometriosis originates are unknown. The high correlation between severe pelvic endometriosis and diaphragmatic endometriosis suggests that the latter originates from endometriotic cells that reach the upper abdomen by circulating with the peritoneal fluid current. Robust evidence regarding the preoperative diagnosis and optimal management of diaphragmatic endometriosis is lacking. Most reports rely on Magnetic Resonance Imaging (MRI) for the radiologic diagnosis of diaphragmatic endometriosis. Although its sensitivity ranged between 78% and 83%, MRI was found to underestimate the extent of diaphragmatic endometriosis in comparison with the surgical findings. Accumulating evidence indicates that asymptomatic diaphragmatic endometriosis is very unlikely to progress, and therefore, could be left in situ when incidentally found. The efficiency of ablative and excisional approaches for symptomatic endometriosis has not been assessed thoroughly to date. In addition, it is unclear whether combining the laparoscopic approach with video-assisted thoracoscopy (VATS) may result in an optimized result. This gap exists due to the lack of data about the association between diaphragmatic and thoracic endometriosis. In this review, we aimed to provide a state of the art description of the current knowledge and gaps about the pathogenesis, diagnostics, and treatment modalities of diaphragmatic endometriosis.

Shoulder injury patterns and trends in the national football league: an epidemiological analysis.

Athletic movements in American football render the shoulder vulnerable to injury. The aim of this study was to explore the epidemiology of shoulder injuries in the National Football League (NFL). Injury data from the 2019-2022 seasons were extracted from official NFL website and secondary resources. Injury parameters included type, severity, week, position and other demographic characteristics. Injury rates were calculated per 1000 athletic exposures (AE) and statistical analyses were used to determine whether any significant differences exist in injury patterns across different positions and types. A total of 6732 injuries were reported during our study period, of which 452(6.7%) were attributed to the shoulder, leading to an injury rate of 4.5 per1000 AE. Linebackers, cornerbacks, wide receivers, and safety positions had significantly higher numbers of shoulder injuries than other defensive and offensive positions. Most injuries were mild (66%, P<0.001). Muscular (40.9%) and ligamentous (37.4%) injuries were the most common injury types. Fractures and ligamentous injuries were significantly more severe than muscular and other injuries (P<0.05). Even though week 17 had the highest mean number of shoulder injuries at 10.75/season, there was no apparent shoulder injury distribution trend across the football season. Shoulder injuries are common in American football. Introducing a deidentified injury registry that provides detailed injury information in the NFL may help develop better prevention strategies and protocols.

"Surviving the dip" after subacromial balloon spacer implantation for massive rotator cuff tear treatment: a retrospective case series.

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period. Sixty-five consecutive patients (55.9 ± 7years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3weeks post-SBSI), Phase II (early rehabilitation > 3-11weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16weeks post-SBSI), Phase IV (early strength training > 16-24weeks post-SBSI), and Phase V (advanced strength training > 24weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05). The mean final follow-up time was 40weeks (range = 24.1-89.7weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty. Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.

Effects of Vibration Therapy on Muscle Strength, Shoulder Range of Motion, and Muscle Biomechanical Properties in Patients with Breast Cancer Undergoing Radiotherapy: A Randomized Controlled Trial

Abstract Objective To investigate the effects of vibration therapy to home-based exercises on shoulder muscle strength, range of motion (ROM), pain-related disability, and muscles viscoelastic properties of shoulder and neck in patients with breast cancer undergoing radiotherapy. Design In this randomized controlled superiority trial was conducted with 38 participants who underwent breast cancer surgery. All patients were randomized into two groups: control group (CG) and vibration group (VG). Both groups performed home-based exercises for 5 days a week for 6 weeks. VG recived additional vibration therapy for 2 days a week for 6 weeks. Shoulder ROM, muscle strength, pain, disability, grip stength, and viscoelastic properties of the pectoralis major, upper trapezius, and sternocleidomastoid were compared pre- and post-intervention. Results VG demonstrated better improvement in shoulder ROM, muscle strength and pain-related disability (p &lt; 0.05), except for internal rotation ROM. Only tone of pectoralis major was significantly higher in VG according to group x time interaction (p &lt; 0.05), no differences were detected in terms of muscle viscoelastic properties in the CG patients (p &gt; 0.05). Conclusion Vibration therapy provided superior improvements in muscle strength, ROM, and pain-related disability compared to home-based exercises alone in patients with breast cancer undergoing radiotherapy in the early postoperative phase.

Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up.

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results. To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs). Case series; Level of evidence, 4. Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed. A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm. At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

Global prevalence and pattern of injuries in basketball players: a systematic review.

Basketball, as a widely popular sport, can be associated with a high risk of injury. This study aimed to provide a comprehensive overview of basketball-related injuries in various groups through the utilization of a systematic review methodology. An extensive search was conducted in the four valid databases using three groups of keywords up to November 2023 based on the PRISMA guidance. Two reviewers independently performed the steps of the study, including study selection, data extraction, and quality assessment. In case of any disagreements, the opinion of a third researcher was sought to achieve agreement in each step. The agreement between the reviewers was examined by computing Cohen's kappa coefficient. The quality assessment of the articles in this study was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools. The prevalence range of injuries in these people was between 0.38% and 92.0%. Ankle injuries in 12 out of 28 studies (42.86%), knee injuries in 7 out of 28 studies (25.00%), head and tooth injuries in 3 out of 28 studies (10.71%), and shoulder and hand injuries in three out of 28 studies (10.71%) had the highest prevalence among various injuries. Five out of six studies (83.33%) showed a higher percentage of the injuries in males. Only a study compared the prevalence of injuries between people with various ages. These findings emphasize the need for injury prevention and management strategies, particularly targeting vulnerable areas like the ankle and knee.

Working conditions, health status, and musculoskeletal disorders among hospital cleaning workers: a cross-sectional study in Turkey.

Cleaning workers face many workplace risk factors and may experience many health problems. In this context, this study aimed to evaluate the musculoskeletal disorders, the health status of hospital cleaning workers, and the working conditions and risk factors affecting the workplace environment. This cross-sectional study was conducted in a university hospital of Turkey. All the cleaning workers who have been working for ≥1 year were participants. The participants' socio-demographic and occupational characteristics, health complaints, workplace risk factors, occupational accidents, and ergonomic nonconformities were observed and questioned. Four hundred thirty-eight cleaning employees participated in the study. In the past year, 19.6% of participants had an occupational accident. Of those, 24.4% did not report it, and 30.2% were absent from work. No pre-employment examination was reported by 36.8% of the participants, and periodic medical examinations were never undergone by 98.4%. Low back pain was experienced by 42.0% of the participants, while 29.5% reported shoulder pain and 28.8% knee pain. While working, 83.1% of the participants bent frequently, 82.2% repeated the same movement, and 73.2% stood for a long time. Chemical substances were the most common workplace risk factors. There were significant differences according to age and gender in almost all musculoskeletal disorders. Gender differences were observed also in various health outcomes and occupational complaints. Repeated bending and prolonged standing were associated with hip/leg and foot/ankle pains; heavy lifting with low back, back, wrist/hand, and ankle/foot pains; and failure to the breaks with shoulder, knee and hip/leg pains. This research investigated the health issues and occupational safety challenges faced by hospital cleaning personnel. Specifically, it examined musculoskeletal disorders and work-related accidents, emphasizing gaps in regular health screenings for these workers. The findings underscore gender variations in these challenges and propose strategies to mitigate ergonomic risks encountered by cleaning staff. Med Pr Work Health Saf. 2024;75(5).

Ultrasound-guided suprascapular nerve block with lidocaine vs. saline combined with physical exercises for the rehabilitation of supraspinatus tendinitis: a randomized double-blind controlled trial

IntroductionShoulder pain is the third leading cause of musculoskeletal complaints in primary care clinics. Its prevalence varies from 14% to 34%. Among all the structures that can cause shoulder pain, the most vulnerable to injury is the tendon of the supraspinatus muscle. The ideal management protocol is still unknown. To date, little is known in the literature about the use of ultrasound-guided suprascapular nerve block as a treatment for supraspinatus muscle tendinitis. Our objective was to assess the effects of the association of a single ultrasound-guided suprascapular nerve block combined with home-based rotator cuff exercises to reduce pain and improve shoulder functioning in patients with supraspinatus tendinitis.MethodsWe evaluated the effect of a single ultrasound-guided suprascapular nerve block on pain and functioning of people with supraspinatus tendinitis. Diagnosis was performed using the positive Jobe test. Due to large disparity between clinical and radiological findings, only clinical diagnostic criteria were used to select patients. This was a double-blind, randomized, controlled, clinical study in which patients in the intervention group (n = 42) received a single injection of 5 ml of 2% lidocaine, while in the control group (n = 41) patients underwent the same procedure receiving saline solution 0.9%. All patients received face to face instructions by an experienced physiotherapist and a leaflet explaining home-based exercises. Pain and functioning were assessed using the Shoulder Pain and Disability Index (SPADI) questionnaire before the procedure, one week and 12 weeks after the procedure.ResultsPatients in both groups improved significantly since the initial evaluation until the 12th week. Intervention group SPADI (pre, 1 week, 12 weeks): 75.80 ± 18.96, 56.25 ± 31.37, 46.31 ± 31.41 (p &amp;lt; 0.001); Control group SPADI: 75.49 ± 16.67, 50.51 ± 27.58, 49.37 ± 30.90 (p &amp;lt; 0.001). However, there were no significant differences between groups (p = 0.291).Discussion/conclusionWe concluded that both lidocaine and saline ultrasound-guided suprascapular nerve blocks reduce pain and improve shoulder functioning in patients with supraspinatus tendinitis. Unexpectedly, the same block performed with saline showed similar results and effects. Clinical Trial RegistrationClinicalTrials.gov, identifier [NCT02495818].

Abstract 4124313: An unusual case of pericardial mass

A 30-year-old male electrician presented with two days of fever and positional left shoulder pain and was found to have elevated inflammatory markers and a large pericardial effusion with echocardiographic evidence of tamponade for which he underwent pericardiocentesis. He was discharged on a course of anti-inflammatory therapy with presumed diagnosis of idiopathic pericarditis based on negative cytology. He returned 6 months later with several weeks of upper respiratory infection symptoms as well as new abdominal discomfort and emesis. On presentation, his vital signs were notable for tachycardia to 113 and cardiac exam was notable for tachycardia, regular rhythm, no rubs or murmurs, nondisplaced precordial impulse, normal jugular venous pressure with Kussmaul sign, and pulsus paradoxus of 6. An electrocardiogram showed sinus tachycardia with diffuse ST segment changes (Figure A). His cardiac biomarkers were unremarkable (troponin 21). His labs revealed normocytic anemia with hemoglobin of 11 and erythrocyte sediment rate above assay. Echocardiogram demonstrated a circumferential complex pericardial effusion with echocardiographic evidence of early tamponade (Figure B, C). A pericardiocentesis was attempted with inability to advance wire within pericardial space. A malignancy workup was initiated. CT demonstrated multi-station thoracic and lower cervical lymphadenopathy, moderate left pleural effusion, and an intrapericardial mass with associated pericardial effusion (Figure D). Cardiac magnetic resonance imaging demonstrated a circumferential intrapericardial non-mobile mass measuring up to 22 mm in thickness posteriorly and the mass was isointense to myocardium indicating low-fat content (Figure E). A supraclavicular lymph node biopsy was obtained with immunohistochemical staining positive for WT1 and calretinin, consistent with metastatic epithelioid mesothelioma of pericardial versus pleural etiology (Figure F). A PET-CT subsequently showed a FDG-avid circumferential anterior pericardial mass and multiple pleural-based lesions concerning for metastatic mesothelioma. He was initiated on pemetrexed/carboplatin systemic chemotherapy. With systemic therapy, his disease has been stable for 6 months. Pericardial mesothelioma is a rare malignancy. This case underscores the diagnostic challenges associated with pericardial mesothelioma and the importance of cancer workup as part of the pericardial effusion workup.

Paralabral cyst in cricketers – A case series

Objectives: Paralabral cysts of the shoulder are rare, and it is usually associated with labral tears. Repetitive stress on the labrum due to increased training history in cricketers can cause micro-tear of the labrum. These tears commonly occur during the early cocking phase in cricketers. These longstanding micro-tears usually form paralabral cysts where the tear operates as a one-way valve. It is fairly common in cricketers who had a longer duration of training and playing history. These cysts are commonly seen in posterior-superior labral tears and SLAP tears. Materials and Methods: Data were obtained from a total of 12 cricketers between the period of March 2022 and July 2023. All these athletes mostly came with complaints of chronic shoulder pain, and the diagnosis was confirmed with magnetic resonance imaging. All these patients were treated by arthroscopic cyst decompression with labral repair. A rehabilitation regimen was administered postoperatively to improve the functional ability of the shoulder and help the athlete to return-to-play. QuickDASH score was performed 12 months postoperatively to assess the effectiveness of the surgical outcome. Results: All the patients reported remission of pain and showed improvement in their QuickDASH scores compared to the pre-operative period. A properly supervised rehabilitation regimen helped the athlete to return to sport. Conclusion: Early diagnosis of paralabral cysts helps in preventing neurological compromise and quicker return-to-play in cricketers. Arthroscopic cyst decompression with labral repair, along with a criteria-based rehabilitation program helps in improving the functional outcome of the athlete.

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

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

Beneficial effects of non-pharmacological interventions for post-stroke pain: A meta-analysis.

Pain is a frequent post-stroke health concern, and several non-pharmacological interventions are commonly employed to manage it. However, few reviews have examined the effectiveness of such interventions, making it difficult to draw conclusions about their usefulness. Furthermore, subgroup analysis based on post-stroke pain level or intervention characteristics is rarely performed. This study aimed to investigate the effectiveness of non-pharmacological interventions and evaluate the significant factors associated with post-stroke pain through subgroup analysis. Systematic review and meta-analysis. Relevant studies were obtained from seven databases, from their commencement up to March 2024, as well as from the gray literature. The PICOS approach was used to evaluate the eligibility criteria of the studies. The RoB-2 tool was used to determine the risk of bias in each randomized trial. Pooled estimations of standardized mean difference and heterogeneity (quantified with I2) were obtained using a random-effects model. The stability of the pooled result was then assessed using the leave-one-out approach. STATA 17.0 was used to run the meta-analysis. Non-pharmacological interventions were effective in reducing pain immediately after intervention (pooled SMDs: -0.79; 95% confidence interval [CI]: -1.06 to -0.53; p < 0.001). The approach involving acupuncture, aquatic therapy, or laser therapy and rehabilitation training was effective for post-stroke hemiplegic shoulder pain. A pooled analysis of non-pharmacological interventions showed that both less than 4 weeks and more than 4 weeks of interventions were effective in alleviating pain in stroke patients. Non-pharmacological approaches appear to be beneficial for reducing post-stroke pain. The outcomes based on the modalities merit further research. Further studies are needed to determine the effects of different modalities on pain intensity following a stroke. Furthermore, to avoid overestimation of intervention efficacy, future randomized trials should consider blinding approaches to the interventions delivered.

ANALYZING THE EFFECTIVENESS OF PROGRAMS ON SHOULDER FUNCTION IN PATIENTS WITH KINESIOPHOBIA.

Background: Involvement of overhead activities is present in many of the games. In volleyball it’s very important. In a competitive atmosphere the collegiate players tend to get injuries, because of that they are developing apprehension. They are becoming kinesiophobia, there are very less studies are available related to this domain, Objective: This study analyzed the effectiveness of SINEX (Shoulder instability neuromuscular exercises) program on shoulder function in patients with kinesiophobia compared to HOMEX (Home based standard care exercise) program. Methods: This is an experimental study; participants were volleyball players who is kinesiophobic. Study setting was KG Campus, study duration is 6 months, and Treatment duration is 12 weeks. Total sample size was 22. By using random sampling method, the population divided into two groups. SINEX was given for Group A and HOMEX for Group B. The outcome measures were SPADI (shoulder pain and disability index) and Spiking velocity. Results: The study assessed the Shoulder function, after the training program, the player improved as well as the player was able to perform the game as well. Both SPADI and spiking velocity show positive improvement. T values of SPADI and Spiking velocity is 11.731 and 2.765 at p&lt;0.05. Conclusion: SINEX (Shoulder instability neuromuscular exercises) program shows better improvement on shoulder function in patients with kinesiophobia compared to HOMEX (Home based standard care exercise) program.

BIOMECHANICAL ASSESSMENT OF SCAPULAR PLANE ELEVATION EXERCISE WITH DIFFERENT MODES OF RESISTANCE IN SUBJECTS WITH AND WITHOUT IMPINGEMENT SYNDROME.

Background: Strengthening the rotator cuff and scapular stabilizers is usually prescribed for subjects with shoulder pain and is done either using dumbbells or TheraBand. The resistance offered by elastic Theraband increases with increase in change from initial length and therefore the resistance offered by TheraBand, and dumbbell differs across the range of motion. Objectives: The purpose of the study is to evaluate the scapular kinematics and activity of prime mover (Anterior Deltoid) while using two different modes of resistance (TheraBand v/s dumbbell) in subjects with and without impingement syndrome. Methods: Twenty-two asymptomatic subjects and 12 subjects with impingement syndrome were included. 3D motion sensors were attached over the humerus, scapulae and trunk to capture movements of the shoulders as the subject performed scapular elevation without load, with yellow Theraband or 2 Kg Dumbbell. Simultaneous electromyography (EMG) activity of anterior Deltoid was measured and analyzed as percentage of maximum voluntary contraction. Results: During arm elevation, scapular Upward rotation was significantly greater at 90° with TheraBand® as compared to unloaded. It was also greater at 120° as compared to unloaded and dumbbell conditions (p&lt;0.001) during elevation and lowering phase. Scapula upward rotation was significantly lesser at 30° with TheraBand® as compared to other conditions. Conclusion: This study found significant downward rotation and anterior tilt of scapula with TheraBand during lowering phase of exercise as compared to dumbbell and unloaded. The alterations of kinematics may help therapists make informed decisions while making exercise prescriptions.

Post-procedural Brachial Neuritis: Clinical, Electrodiagnostic and Neuroimaging features.

Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis is common. Imaging is important to confirm the diagnosis of post-procedural brachial neuritis and exclude other etiologies. Clinical, electrodiagnostic, and neuroimaging features of patients with post-procedural brachial neuritis from a single quaternary care institution were identified and analyzed. Six (2 female) patients were identified with median age 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1-day to 2-weeks. The initial symptom for 5/6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root, and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions of these nerves were seen in 3/6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. Post-procedural brachial neuritis is an underrecognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of hourglass constrictions in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings. HGC = hourglass constriction; EDX = electrodiagnostic; IRB = Institutional Review Board; ACDF = anterior cervical discectomy and fusion; NRS = Numerical Rating Scale; MUAP = motor unit action potential.

Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada.

To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services. All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age. Multivariate regressions were used to examine determinants of the outcomes. In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI. Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs.