Shoulder Rating Questionnaire Research Articles

Tradução, adaptação cultural, validade e confiabilidade do questionário de classificação do ombro para uso no Brasil

ObjectiveTo translate and culturally adapt the Shoulder Rating Questionnaire (SRQ) to the Brazilian Portuguese language, and to determine its validity, reliability and sensitivity to change in patients with functional impairment of the shoulder. MethodsAfter translation and back‐translation of the original version by four independent translators, the instrument was reviewed by a committee of experts and subsequently applied to eight patients with shoulder injury (target audience) to produce the Portuguese version. Then, this version was applied to 102 patients selected from four reference centers for functional treatment of the shoulder, who had a variety of clinical diagnoses, educational levels, socioeconomic, and cultural backgrounds. The evaluation was performed twice with an interval of four weeks between each application. ResultsThe Brazilian version of SRQ was equivalent in terms of semantics and showed good levels of reliability (Cronbach's Alpha=0.89 and ICC=0.83). The reproducibility was high (Spearman Correlation Coefficient=0.82) and validity of the items that ranged from 0.54 to 0.99 was considered excellent. The Cohen's d and T test for repeated measures showed that the instrument is able to monitor and track improvements in shoulder function. ConclusionPsychometric criteria were found, which justify the applicability of the Brazilian version of SRQ in individuals with shoulder functional impairments.

Effectiveness of Home Exercise on Pain, Function, and Strength of Manual Wheelchair Users With Spinal Cord Injury: A High-Dose Shoulder Program With Telerehabilitation

ObjectiveTo test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized. DesignA pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk). SettingSubjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center. ParticipantsA convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination. InterventionsA 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing. Main Outcome MeasuresPrimary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius. ResultsPain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ22=5.10, P=.014), DASH Index (χ22=5.41, P=.012), and SRQ (χ22=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points. ConclusionsA high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.

Efficacy of a combined physical and occupational therapy intervention in patients with subacute neuralgic amyotrophy: A pilot study

Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and occupational therapy program for patients recovering from NA. Evaluation of the effectiveness of a multidisciplinary intervention program for patients with subacute NA. We performed a within subject proof-of-principle pilot study in eight patients with subacute NA. Patients followed 8 hours of physical and 8 hours of occupational therapy spread over a 16-week period. The Canadian Occupational Performance Measure (COPM) and Shoulder Rating Questionnaire (SRQ). Disability of Arm Shoulder and Hand (DASH). Improvements (mean (95% CI)) were found in the performance and satisfaction scores of the COPM +2.3 (0.9-3.7) and +1.4 (0.4-2.4) points, respectively and the SRQ +14.8 (7.4-22.0) points. The majority of patients (6 out of 8) also demonstrated improvements in the DASH. The proposed physical and occupational therapy program, may be effective for patients with subacute NA, as demonstrated by improvements in activity, performance and participation.

Shoulder muscle electromyographic activity and stiffness in patients with frozen shoulder syndrome: six-month follow-up study

Th is study evaluated changes in shoulder muscle isometric endurance, deltoideus and trapezius muscle electromyographic activity (EMG) and stiff ness in patients with frozen shoulder syndrome (FSS) before and aft er manipulation under general anaesthesia (MUA). Eighteen FSS patients with mean age of 53±9 years participated. Isometric endurance of shoulder muscles was characterized by endurance test time and deltoideus and trapezius muscles EMG activity that were assessed by electromyograph during weight holding in hand until exhaustion. Stiff ness of deltoideus and trapezius muscles was assessed by myotonometer (MYOTON-3). Patients were screened by self-administered shoulder rating questionnaire (SRQ). Data was collected before one and six months aft er MUA. Six months aftMUA endurance test time remained reduced (p<0.05) for the involved extremity as compared with the uninvolved extremity. Deltoideus and trapezius muscle EMG activity decreased (p<0.05) at the end of the endurance test, whereas in the beginning of the endurance test the trapezius muscle EMG was lower (p<0.05) for the involved extremity. Deltoideus and trapezius muscle stiff ness did not diff er (p<0.05). SRQ score points decreased (p<0.05) one and six months aft er MUA. In conclusion, six months aft er MUA the shoulder muscle EMG activity and stiff ness for the involved extremity was normalized in patients with FSS.

Superior clavicle plate with lateral extension for displaced lateral clavicle fractures: a prospective study

BackgroundUntil now there have been no prospective studies describing the results of using the superior clavicle plate with lateral extension in patients with displaced lateral clavicle fractures (Neer type 2). The purpose of this study was to evaluate the results of applying this plate for this specific type of fracture.Materials and methodsIn this prospective study, seven patients (mean age 43, M:F; 6:1) with a fresh displaced lateral clavicle fracture were evaluated with a mean follow-up of 10 months. Analysis included functional and subjective outcome, time until union, time until return to work, and complications.ResultsAll patients achieved clinical and radiological union within 6–12 weeks. Full range of motion as well as a return to work was achieved in most cases within 2 weeks. The mean Constant score was 98 (range 90–100), the DASH score was 3.6 (range 0–11.4), and the Shoulder Rating Questionnaire score was 97 (range 96–100). No major complications were encountered. Three patients required plate removal: two because of a prominent and subcutaneous plate and one because of an intra-articular screw.ConclusionsIn this study, use of the superior clavicle plate with lateral extension yielded excellent results in the treatment of this difficult fracture. In particular, patients acquired full range of motion within 2 weeks, reflecting the stability of the osteosynthesis achieved with this implant.

Shoulder Pain among Rehabilitated Spinal Cord Injured Persons Using Manually Propelled Wheelchairs in the Gaza Strip: A Survey

Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities. Purpose : This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic activities. It also aimed to detect the degree of satisfaction with shoulder functioning wheelchair users who were paraplegic due to spinal cord injury, in the Gaza strip. Methods: Cross sectional study design was used to collect data from 80 persons with paraplegia, post rehabilitation, who were still using manual wheelchairs (MWC) for ambulation. After giving informed consent, the selected persons were interviewed directly in their homes, and filled questionnaires which included the demographic data, Wheelchair User?s Shoulder Pain Index (WUSPI) and Shoulder Rating Questionnaire (SRQ). Results: The prevalence rate of shoulder pain among paraplegics who use manual wheelchairs was 62%. Pushing a wheelchair for 10 minutes or more, and propulsion up ramps or inclines outdoors were the most common activities that caused and exacerbated shoulder pain. Sixty four percent from among the study sample mentioned that they had no limitation in shoulder-using ability during daily personal and household activities, while the rest experienced different degrees of limitation. Seventy-four percent reported no limitation during recreational or athletic activities, while the rest (26%) agreed that pain has variably limited their participation in these activities. Fourteen percent from the sample rated the overall degree of satisfaction with their shoulder functioning as fair, and the rest rated their satisfaction from good to excellent. Conclusion : Shoulder pain, ranging from mild to severe, was highly prevalent among SCI paraplegics who use MWCs during their usual activities, and other activities which involve wheelchair propulsion. About two- thirds of the subjects reported no limitation in shoulder use during daily personal and household activities and in recreational or athletic activities. doi 10.5463/DCID.v23i2.105

Residual Complaints After Neuralgic Amyotrophy

ObjectiveTo develop recommendations regarding outcome measures and topics to be addressed in rehabilitation for persons with neuralgic amyotrophy (NA), this study explored which functions and activities are related to persisting pain in NA and which questionnaires best capture these factors. DesignA questionnaire-based survey from 2 cross-sectional cohorts, one of patients visiting the neurology outpatient clinic and a cohort seen at a multidisciplinary plexus clinic. SettingTwo tertiary referral clinics based in the Department of Neurology and Rehabilitation from a university medical center provided the data. ParticipantsA referred sample of patients (N=248) with either idiopathic or hereditary NA who fulfilled the criteria for this disorder, in whom the last episode of NA had been at least 6 months ago and included brachial plexus involvement. InterventionsNot applicable. Main Outcome MeasuresTwo custom clinical screening questionnaires were used as well as the Shoulder Rating Questionnaire–Dutch Language Version, the Shoulder Pain and Disability Index (SPADI), the Shoulder Disability Questionnaire (SDQ), and Overall Disability Sum Score. ResultsThe survey confirms the high prevalence of persisting pain and impairments. More than half of the patients were restricted by pain, while in those without pain 60% experienced residual paresis. Correlations show an intimate relation between pain, scapular instability, problems with overhead activities, and increased fatigability. A standard physical therapy approach was ineffective or aggravated symptoms in more than 50%. ConclusionsPain and fatigue are strongly correlated to persisting scapular instability and increased fatigability of the affected muscles in NA. Our results suggest that an integrated rehabilitation approach is needed in which all of these factors are addressed. We further recommend using the SPADI and SDQ in future studies to evaluate the natural course and treatment effects in NA.

Recovery of shoulder muscle function characteristics and active range of motion in patients with frozen shoulder after manipulation under anesthesia

The purpose of this study was to evaluate the changes in shoulder muscle isometric strength, endurance, and shoulder active range of motion in patients with frozen shoulder syndrome after manipulation under general anesthesia. Thirteen patients (eight women, five men, median age 53 years) with diagnosis of frozen shoulder syndrome participated in this study. Shoulder muscle isometric strength, active range of motion in flexion, extension, abduction, and shoulder muscle endurance were measured before manipulation under general anesthesia and at 1 and 6 months postoperatively. Patients were also screened by self-administered shoulder rating questionnaire. Six months after manipulation under general anesthesia, shoulder muscle isometric strength, active extension, and abduction for the involved extremity did not differ significantly compared with the uninvolved extremity. On the other hand, shoulder muscle isometric endurance time remained significantly shorter (p = 0.021) and active flexion remained significantly lower (p = 0.039) for the involved extremity (66.0 ± 42.9 s and 162.5 ± 16.2°, respectively) compared with the uninvolved extremity (98.0 ± 32.2 s and 171.5 ± 6.3°, respectively). Moreover, shoulder rating questionnaire scores significantly improved at the last follow-up (from 49.7 ± 8.7 to 80.1 points; p < 0.001). The recovery of shoulder muscle isometric endurance in patients with frozen shoulder syndrome after manipulation under general anesthesia was more delayed than recovery of isometric strength of these muscles or shoulder active range of motion. Shoulder muscle endurance training program should be recommended for patients after manipulation under general anesthesia.

Western Ontario Osteoarthritis Shoulder (WOOS) index: a cross-cultural adaptation into Swedish, including evaluation of reliability, validity, and responsiveness in patients with subacromial pain

The aim of the present study was to translate the Western Ontario Osteoarthritis Shoulder (WOOS) index into Swedish and to test its validity, reliability, and responsiveness in patients with subacromial pain. The validity of the WOOS translation was tested in 54 patients who completed the WOOS and the Shoulder Rating Questionnaire, Swedish version (SRQs). Of these patients, 46 were retested to assess reliability. Responsiveness was evaluated in 29 subjects who completed the WOOS and SRQs before surgery and again at 3 months after surgery, when they also rated perceived change in shoulder function. The relationship between the questionnaires and patient-perceived improvement was assessed. A high correlation was found between the Swedish version of WOOS and the SRQs. The correlations were similar in a group of working patients (r = -0.832) and in all patients (r = -0.843; P < .001). A high degree of agreement between WOOS at test and retest was also observed. A Bland-Altman plot showed a small mean difference and no trend across the range of WOOS values. A strong significant agreement was also shown by a κ value of 0.649 (P < .001) and an intraclass correlation coefficient of 0.95 (95% confidence interval, 0.92-0.97, P < .001) as well as by a low difference between the test and retest means. Responsiveness, calculated by standardized response mean, was excellent (1.02). The results of the present study provide evidence that the Swedish version of WOOS is valid, reliable, and responsive in patients with subacromial pain and performs similarly to the original Canadian version.

Improvement in Functional Ability and Quality of Life Takes Place among Patients with Supraspinatus Tendinitis Regardless of the Type of Intervention

Objectives. The purpose of this study is to investigate the functional ability and state of health before and after three different treatments of patients (n=156) with shoulder problems. Design. This is a comparative study using convenience sampling and Shoulder Rating Questionnaire, the Short Form-36 Health Survey self-evaluation questionnaires, and metabolic equivalent (MET), prior to and after intervention. The patients in Group 1 had an arthroscopic operation while Group 2 had an open acromioplasty. The patients in Group 3 had merely received conservative treatment. Results. Improvement has occurred regardless of the type of intervention. However, a change is notable less evident in the Conservative group, which at least in part can be explained by their higher initial scores (measurement 1); their situation has simply been better already from the start, and this is perhaps why they have not been placed onto an operation waiting list. Conclusion. Even if conservative treatment appears to result in comparatively poorer outcomes, the role of physiotherapy should not be disregarded. Physiotherapy cannot replace essential surgical operations, but physiotherapy is able to significantly alleviate patients' experiences of pain.

Paper # 136: Analysis of Evidence-Based Medicine for Shoulder Instability

This review summarizes the process of proper development and testing of the scoring systems, discusses the role that they should play in the use of clinical research with respect to shoulder instability, and explains the dichotomy of postoperative recurrence and high shoulder scores. Clinical research has become a major influencing factor in the determination of treatment choice in our society. Outcome data has been requested by third party payors, patients, and administrators alike. Currently, there are numerous scoring systems that have been used to evaluate the efficacy for treatment of shoulder instability. Some of these are based upon the specific condition of shoulder instability; however, other systems are broadly based to incorporate a spectrum of shoulder conditions. The scoring systems which address instability include the Rowe/Modified Rowe, the American Shoulder and Elbow Surgery (ASES), the Shoulder Rating Questionnaire (SRQ), the Melbourne Instability Shoulder Score (MISS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Western Ontario Shoulder Instability Index (WOSI), the Oxford Instability Score (OIS), the Constant-Murley (CM), the Athletic Shoulder Outcome Rating Scale (ASORS), the University of California Los Angeles (UCLA), and the Simple Shoulder Test (SST). This review summarizes the process of proper development and testing of the scoring systems, discusses the role that they should play in the use of clinical research with respect to shoulder instability, and explains the dichotomy of postoperative recurrence and high shoulder scores. The scoring systems were evaluated for proper development, reliability, validity, and responsiveness for a homogeneous subset of patients with known instability. Reliability was determined by both the intraclass correlation coefficient (ICC) and Internal Consistency. Responsiveness was shown by both the Standardized Response Mean and the Effect Size. Validity was evaluated taking into account construct, criterion and content validity. Only 3 of the 11 scoring systems, the MISS, the DASH, and the WOSI, appear to have used an adequately described developmental process. The SRQ, MISS, WOSI, OIS, and SST were shown to be reliable for patients with instability. The SRQ, MISS, WOSI, OIS, and ASES have all been shown to be largely responsive. The SRQ, MISS, OIS, and SST all appear to have moderate validity. The ASES and the WOSI both have significant support to conclude high validity for patients with instability. However, the ASES does not appear to optimally determine outcome measurement and was found to be less responsive in patients with instability compared with other pathologies. There are only two scoring systems, the WOSI and the MISS, which should be used as the universally accepted shoulder scoring systems for shoulder instability. The SRQ and OIS were found to be less responsive for patients with instability compared to patients with other shoulder dysfunctions. Other scoring systems lack interrater reliability, validity and/or responsiveness for patients in the instability population. The ASES scoring system should be used for patients with upper extremity problems other than those with shoulder instability, as this instrument has been proven to be valid, reliable and responsive. Standardizing the scoring system used in clinical studies performed for the treatment of shoulder instability will lead to more consistent results as well as results that may be able to be compared between studies.

Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer

Shoulder motion loss following surgical treatment of breast cancer is common and may be associated with surgery-related soft tissue changes and altered shoulder kinematics. Knowledge of short term biomechanical changes at the shoulder will inform treatment decisions and may help prevent the development of shoulder pathology. Shoulder motion loss following surgery also impacts quality of life and shoulder function, and measuring function with a shoulder-specific tool may direct rehabilitation. This study examined the short term effects of surgery on scapula kinematics and function in breast cancer survivors. Bilateral three-dimensional scapular kinematics were quantified before and after surgery for unilateral breast cancer and analyzed with repeated measures ANOVA. Shoulder function was assessed with the Shoulder Rating Questionnaire (SRQ) and analyzed with ANOVA. Subjects (n=11) demonstrated statistically significant increases in scapula internal rotation on their involved side following surgery. An intention to treat analysis on all enrolled subjects supported this finding. The findings suggest that soft tissues restrictions impact short-term scapula motion following surgery for breast cancer. Significantly poorer shoulder function was reported for pain, recreation/athletic activities and total SRQ score after surgery. The SRQ appears sensitive enough to identify areas of life affected by changes in shoulder function following surgical intervention for breast cancer.

High-dosage medical exercise therapy in patients with long-term subacromial shoulder pain: a randomized controlled trial

Exercise therapy is a commonly used conservative therapy for long-term subacromial pain. However, there is no consensus regarding what type of exercises and dosage is most effective. The aim of this study was to compare the effect of two exercise programmes: 1) high-dosage (HD) medical exercise therapy versus 2) low-dosage (LD) exercise therapy programme for subjects with long-term subacromial pain. This study used a randomized, controlled clinical trial with an intention-to-treat analysis. Sixty-one subjects were randomly assigned by concealment either to an HD medical exercise therapy group (n = 31) or to an LD exercise therapy group (n = 30). Pain (visual analogue scale [VAS]) and function (Shoulder Rating Questionnaire [SRQ]) were measured at inclusion, at end of treatment and at 6 and 12 months follow-up. There were no differences between groups at inclusion (baseline) regarding any variables. During the three months treatment period, five subjects (8%) dropped out, and another seven (11%) dropped out at one-year follow-up. At the end of treatment, both pain and function had improved significantly in favour of the HD therapy, between-group differences in VAS were -2.7 (-3.9 to 0.9), and for activity limitations, the between-group differences in the SRQ increased by 24.5 points (14.5-35.7). The differences between groups were both statistically and clinically significant at 6 and 12 months follow-up. In subjects with long-term subacromial pain syndrome, HD medical exercise therapy is superior to a conventional LD exercise programme. For clinicians to obtain similar positive results with HD medical exercise therapy, factors such as good communication skills, constant close personal supervision during exercise treatment and having from three to five subjects in a group setting are important.

A Shoulder Health Survey: Correlating Behaviors and Comorbidities With Shoulder Problems

Shoulder pain and loss of shoulder function are common complaints reported by a variety of patients. This article suggests that shoulder pain and loss of function are directly proportional to lifestyle choices, including smoking and obesity. To investigate possible relationships between lifestyle choices and shoulder health, the authors conducted an online survey combining the Oxford Shoulder Questionnaire, the Shoulder Rating Questionnaire, and the Subjective Shoulder Rating System. Data were collected from 166 respondents. Statistical significance was set at P < .05. The data show a statistically significant correlation between decreased shoulder function and cigarette smoking and a similar correlation between decreased shoulder function, elevated cholesterol, and obesity.

The Dose-Response Effect of Medical Exercise Therapy on Impairment in Patients with Unilateral Longstanding Subacromial Pain

Objectives:The primary aim of this study was to investigate the effect of medical exercise therapy in shoulder impingement patients, along with possible correlations between impairment variables.Study Design:A prospective unblended randomized clinical trial.Methods:Over four months, 61 participants were randomly assigned into a high-graded exercise therapy group (HD) (n=31) and into a low-graded exercise therapy group (LD) (n=30). Prognostic variables were similar between the groups at baseline. Five (8%) patients dropped out during the treatment period, and another four (6%) dropped out before followup. Pain was a composite score of a visual analogue scale (VAS). Isometric strength was measured during four resisted break tests on the shoulder. Function was measured by means of a functional assessment questionnaire (Shoulder Rating Questionnaire, SRQ). Both groups trained three times per week for twelve weeks, with tests pre- and posttraining and six months follow-up.Results:The HD group achieved significantly (p < 0.05) better outcome effects than the LD group for pain, range of motion, isometric functional strength and function, but both groups increased function from pretest to posttest.Conclusions:In patients with uncomplicated subacromial pain syndrome, medical exercise therapy is an efficient treatment alternative, where high-grade doses should be emphasized. A major limitation is that the measurements were not undertaken by another person than the treating physiotherapists.

Critical appraisal of subjective outcome measures used in the assessment of shoulder disability

Objective measures can be impractical in some settings, because they are time consuming and require face-to-face contact. More recently, there is an increasing trend towards the use of subjective outcome measures. Hence, in this article, five common subjective shoulder outcome measures are critically appraised in terms of their development, validity, reliability, responsiveness and clinical application. Following an extensive literature search, five common shoulder patient-based scores were identified: Disability of Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ-UK), Shoulder Pain and Disability Index (SPADI), and the Shoulder Rating Questionnaire (SRQ). These questionnaires were then critically appraised in terms of their development process, validity, reliability, responsiveness, and clinical application. The SDQ-UK has shown good construct validity but there is no data available regarding internal consistency, reliability and responsiveness. The SPADI has good internal consistency, fair reliability with adequate criterion and construct validity. The DASH has shown to have good construct validity, excellent test-re-test reliability and responsiveness to change. The OSS has good sensitivity, validity and responsiveness. Though SRQ has good internal consistency, its reproducibility and responsiveness are poor. Based on this critical appraisal, the DASH received the best ratings for its clinimetric properties followed by the OSS.

Comparison of two patient-based outcome measures for shoulder instability after nonoperative treatment

This study compared the responsiveness and minimal clinically important differences of the Oxford Instability Shoulder Score (OISS) and Shoulder Rating Questionnaire (SRQ). Ninety-three patients referred to physiotherapy with shoulder instability (100 shoulders) completed the questionnaires at the initial appointment and at 1 and 9 months later. A subjective rating of change was also obtained. Both questionnaires were able to detect change (effect sizes 1.16 OISS and 0.99 SRQ). The OISS change scores correlated more consistently with patients' subjective responses. The minimal detectable change (MDC90) scores were 16% (7 points) for the OISS and 17% (8 unweighted points) for the SRQ. The minimal clinically important difference (MCID) was between 9%, 4.5 points ("slightly better" and "much better") and 13.5%, 6.5 points ("much better") for the OISS, dependent on the subjective descriptors used, and 11% (4 unweighted points) for SRQ. The MCID change scores varied in relation to the baseline level of function.

Intra-articular corticosteroid injection for the treatment of idiopathic adhesive capsulitis of the shoulder.

Treatment for idiopathic adhesive capsulitis or frozen shoulder of the shoulder is controversial. The hypothesis of the study is that intra-articular corticosteroid injection in the early stages of idiopathic adhesive capsulitis will lead to a rapid resolution of stiffness and symptoms. This is a retrospective cohort study of only patients with stage 1 or stage 2 adhesive capsulitis. The diagnosis was made by history and physical examination and only when other causes of pain and motion loss were eliminated. Stage 1 adhesive capsulitis was defined as significant improvement in pain and normalization of motion following intra-articular injection. Stage 2 included patients who had significant improvement in pain and partial improvement in motion following injection. Seven patients with stage 1 and 53 patients with stage 2 comprised the baseline cohort. The mean age was 52 years (range: 30 to 78); 46 patients were female and nine patients had diabetes mellitus. Patients completed a physical examination as well as a shoulder rating questionnaire for symptoms and disability. Criteria for resolution were defined as forward flexion and external rotation to within 15 degrees of the contralateral side and internal rotation to within three spinal levels of the contralateral side. Forty-four of the patients out of 60 met the criteria for recovery at a mean of 6.7 months. The mode and median time to recovery was 3 months. The mean score at final follow-up for 41 patients using the shoulder-rating questionnaire of L'Insalata was 90 (range 52-100). The mean time to recovery for the stage 1 patients was 6 weeks (range: 2 weeks to 3 months), and it was 7 months for stage 2 patients (range: 2 weeks to 2 years). Glenohumeral corticosteroid injection for early adhesive capsulitis may have allowed patients to recover motion at a median time of 3 months. In many cases, the patients had improvement prior to the 3-month mark; however, that was the routine time for follow-up. Patients with stage 1 disease tended to resolve more rapidly than stage 2 patients. Prompt recognition of stage 1 and stage 2 idiopathic adhesive capsulitis and early injection of corticosteroid with local anesthesia may be both diagnostic and therapeutic.

Clinical Trial of Exercise for Shoulder Pain in Chronic Spinal Injury

The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.

Outcome and Structural Integrity after Arthroscopic Rotator Cuff Repair Using 2 Rows of Fixation

Background Although arthroscopic repairs of the rotator cuff are becoming increasingly popular, security of fixation remains a concern. Two-row repairs have been described, but clinical outcome reports have primarily involved open techniques. Hypothesis An arthroscopic repair technique that uses 2 rows of fixation produces satisfactory outcome and structural integrity by ultrasonography. Study Design Case series; Level of evidence, 4. Methods Forty-eight patients (52 shoulders) with a full-thickness, but fully reducible, rotator cuff tear who met the inclusion criteria were treated with an arthroscopic rotator cuff repair using 2 rows of suture anchors. The mean tear size was 2.47 cm (range, 1-4 cm). Patients were evaluated by subjective functional assessment (L'Insalata Shoulder Rating Questionnaire), clinical examination, including measured strength testing, and ultrasonography. Results At a mean follow-up of 30 months (minimum of 2 years), functional scores improved from a mean of 42 preoperatively to 93 postoperatively (P <. 001). Active range of motion was increased in all measured planes (P <. 001). Strength was also increased in elevation (P <. 001), external rotation (P <. 001), and internal rotation (P =. 033). Nine of the 52 shoulders (17%) had evidence of retear or persistent defect on postoperative ultrasonography. There were no differences detected in functional scores between those with an intact repair and those with a defect, but those with an intact repair were stronger in elevation (P =. 006) and external rotation (P =. 001). Conclusion An arthroscopic 2-row rotator cuff repair produces excellent functional outcome and repair integrity comparable with previously reported open repairs. Presence of a defect after repair did not appear to affect patient-reported function and return to preinjury activity but did affect measured strength.