Symptoms Of Shoulder Pain Research Articles

A prospective observational study on the beneficial effects and tolerability of a cetylated fatty acids (CFA) complex in a patch formulation for shoulder tendon disorders

BackgroundThe advancement of physiopathological knowledge of tendon structures has shown that, in conditions of overload, there is the onset of both degenerative phenomena, such as the production of metalloproteases, apoptosis of tendon cells and neoangiogenesis, and regenerative and protective phenomena, such as the production of IGF-1 and nitric oxide. Tendinopathy results from the imbalance between these two groups of factors, leading to degeneration, weakening, and fissuring of the tendons, with the presence of local pain. The aim of the study was to evaluate the efficacy and tolerability of cetylated fatty acids (CFA) patch formulation in the control of acute localized shoulder pain and recovery of function in patients with tendinopathies.MethodsA prospective, single-center, no-profit observational study conducted in accordance with Good Clinical Practice. Thirty patients with recent onset shoulder pain symptoms (1–3 months) related to bursitis and tenosynovitis, with a diagnosis of shoulder tendon pathology confirmed by ultrasound examination, was evaluated for shoulder pain and function using the Constant Murley Score. Patients used 1 patch containing CFA for 8 h per day for 10 days. At 10 (V1) and 35 (V2) days after the first visit (V0), the Constant Score, treatment compliance and product tolerability were evaluated.ResultsThirty patients completed the treatment. At V0 the mean Constant Score (CS) was 32.37 ± 11.86, during V1 the mean CS was 50.68 ± 14.30, and at V3 the mean CS was 51.07 ± 15.29. The CS increased significantly between V0 and V1 (p < 0.0001) but did not vary significantly between V1 and V2 (p = 1). The tolerability of the product was excellent.ConclusionsApplication of the CFA-based patch for 10 consecutive days in patients with shoulder tendinopathies was effective in reducing local pain and resulted in a good recovery of function. The results achieved at day 10 were maintained for 25 days, until the follow-up visit at day 35. CFA-based patch, thanks to their efficacy and tolerability, seems to be a promising solution to improve pain and functionality in subject with shoulder tendinopathy.Trial registrationThe study was approved by the Ethics Committee of Azienda USL Toscana Nord Ovest (protocol code 2018RIAB105) and conducted in accordance with Good Clinical Practice and the ethical principles outlined in the Declaration of Helsinki.

Shoulder Pathology on Magnetic Resonance Imaging in Asymptomatic Elite-Level Rock Climbers.

Background:The prevalence of findings on shoulder magnetic resonance imaging (MRI) is high in asymptomatic athletes of overhead sports.Purpose/Hypothesis:The purpose of this study was to determine the prevalence of atypical findings on MRI in shoulders of asymptomatic, elite-level climbers and to evaluate the association of these findings with clinical examination results. It was hypothesized that glenoid labrum, long head of the biceps tendon, and articular cartilage pathology would be present in >50% of asymptomatic athletes.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 50 elite climbers (age range, 20-60 years) without any symptoms of shoulder pain underwent bilateral shoulder examinations in addition to dedicated bilateral shoulder 3-T† MRI. Physical examinations were performed by orthopaedic sports medicine surgeons, while MRI scans were interpreted by 2 blinded board-certified radiologists to determine the prevalence of abnormalities of the articular cartilage, glenoid labrum, biceps tendon, rotator cuff, and acromioclavicular joint.Results:MRI evidence of tendinosis of the rotator cuff, subacromial bursitis, and long head of the biceps tendonitis was exceptionally common, at 80%, 79%, and 73%, respectively. Labral pathology was present in 69% of shoulders, with discrete labral tears identified in 56%. Articular cartilage changes were also common, with humeral pathology present in 57% of shoulders and glenoid pathology in 19% of shoulders. Climbers with labral tears identified in this study had significantly increased forward elevation compared with those without labral tears in both active (P = .026) and passive (P = .022) motion.Conclusion:The overall prevalence of intra-articular shoulder pathology detected by MRI in asymptomatic climbers was 80%, with 57% demonstrating varying degrees of glenohumeral articular cartilage damage. This high rate of arthritis differs significantly from prior published reports of other overhead sports athletes.

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study

ObjectiveTo develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator...

Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis.

Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.

Auricular acupuncture for shoulder pain: A protocol for systematic review and meta-analysis.

Background:Shoulder pain is a common problem in outpatient medical practice. Recent studies show that acupuncture has therapeutic effect on releasing symptoms of shoulder pain. The aim of this systematic review and meta-analysis is to access the efficacy and safety of auricular acupuncture for shoulder pain.Methods:Eight databases will be searched for randomized controlled trials of auricular acupuncture in the treatment of shoulder pain with retrieval time up to September 2020, including PubMed, Embase, The Cochrane Library, Web of science, CNKI, VIP, CBM, and Wangfang Data databases. We will evaluate the methodological quality of the included studies by using Cochrane Risk of Bias tool and conduct data analysis with Review Manager Software.Results:The results of this study will be disseminated through a peer-reviewed journal publication.Conclusion:The systematic review will provide up-to-date evidence for the efficacy and safety of auricular acupuncture in treating shoulder pain.PROSPERO registration number:CRD 42021238797

Effectiveness on knowledge about computer vision syndrome among medical coding trainee in medical coding training institute in urban Chennai, Tamil Nadu - A cross- sectional study.

Context:Electronic devices, laptops, tablets, ipad and smart phones are an integral part of one's life both in work and personal space. Excessive usage of these devices had led to health-related problems of which computer vision syndrome (CVS) is at risk of becoming a major public health issue.Aims:Our study aimed to assess the pre-test and post-test level of knowledge regarding CVS among the medical coding trainees and also to determine the effectiveness (Video Teaching Programme) of knowledge about the CVS among them.Methods and Material:After obtaining ethical committee clearance using universal sampling method 480 medical coding trainees working in a firm was included in this study. A structured questionnaire was used to interview and a video teaching programme was given between the pre and post-test sessions for about 45 minutes regarding the effects of Computer Vision Syndrome.Results:The level of knowledge about CVS among medical coding trainees in the pre-test and post-test was 280 (58.3%) and 8 (1.7%) had inadequate knowledge, respectively. With regards to adequate level of knowledge 24 (3%) and 328 (68.3%) had in pre-test and post-test phase, respectively. The comparison of knowledge shows a very good improvement among the medical coding trainees which was significant (p < 0.001).Conclusions:The study highlights health education as an important factor in increasing the knowledge. From a primary care point of view, knowledge regarding CVS helps in differentiating and addressing the ocular symptoms, headache and shoulder pain symptoms of other aetiology if history is elicited properly.

Associations of neck and shoulder pain with objectively measured physical activity and sedentary time among school-aged children.

Objectives The potential effects of physical activity and sedentary time on children's increasing neck and shoulder pain are unclear. The aim of this cross-sectional study was to evaluate the associations between objectively measured physical activity or sedentary time and neck and shoulder pain in children. Methods Children (n=905; 10-15 years old) filled in an electronic questionnaire during school hours on the frequency of their neck and shoulder pain. Daytime moderate to vigorous physical activity and sedentary time were measured objectively with an ActiGraph accelerometer. A multinomial logistic regression was applied to study the associations. The results were adjusted for age, gender, body mass index and bedtime. Results Neck and shoulder pain experienced at least once a week was reported by 26.1% of children. A higher proportion of boys (45.9%) than girls (24.2%) achieved at least 60min of moderate to vigorous physical activity/day (p<0.001). Girls were more sedentary than boys (sedentary time 66.4 vs. 63.1%) (p<0.001). Higher moderate to vigorous physical activity time was associated with a lower probability of experiencing neck and shoulder pain among boys, but not among girls. No association was found between sedentary time and neck and shoulder pain. Conclusions A quarter of the girls and boys reported frequent neck and shoulder pain. Boys achieved more moderate to vigorous physical activity than girls and higher moderate to vigorous physical activity was associated with a lower probability of having neck and shoulder pain, but only in boys. Neck and shoulder pain is the most common musculoskeletal pain and its prevalence is increasing. Preventing childhood pain is important, as neck and shoulder pain causes restrictions in daily living and is persistent to adulthood. Our study showed, that boys with more moderate to vigorous physical activity, had less weekly neck and shoulder pain symptoms. The present results are an addition to the list of benefits of physical activity and are valuable to, for example, healthcare personnel and teachers, who guide and teach children and adolescents. Families can benefit from new knowledge when considering supportive parenting activities. Municipalities can use the new information to design services for children or families.

Clinical Tests of the Shoulder: Accuracy and Extension Using Dynamic Ultrasound.

Shoulder pain is a common musculoskeletal disorder that has a significant impact on the patient's quality of life and functional health. Because the shoulder joint is a complex structure, the relevant symptoms of shoulder pain may not directly reflect the underlying pathology. Hence, several shoulder tests have been developed to examine shoulder problems, and their diagnostic accuracy varies. Familiarization with the performance of those physical tests and their strength and limitation are of utmost importance for physicians dealing with shoulder disorders. Therefore, the present narrative review focuses on summarizing the most commonly used tests in physical examination and their diagnostic performance on several shoulder pathologies. This article also discusses how ultrasound imaging can serve as an extension of those tests.

Arthroscopy of the symptomatic shoulder arthroplasty

Assessment of a painful or stiff shoulder arthroplasty can be challenging. The cause of pain can sometimes be easily identified. However, some patients have normal levels of inflammatory markers, normal plain films, and no clinical signs to indicate a diagnosis. Indolent organisms may not raise blood marker levels or result in obvious radiologicfindings such as loosening. We report the utility of performing arthroscopy in these patients for a diagnostic advantage. We retrospectively reviewed the health records of all patients who underwent diagnostic shoulder arthroscopy over a 3-year period. Patients were included if they were aged 18 years or older, had undergone previous arthroplasty surgery, and had symptoms of shoulder pain or stiffness. Patients were excluded if they had any traditional symptoms of infection or had a raised serum white cell countor C-reactive protein level prior to diagnostic arthroscopy. Fourteen patients met the initial inclusion criteria. The mean interval between index surgery and arthroscopic evaluation was 65.4 months (standard deviation, 58 months; range, 17-192 months). Arthroscopic biopsy specimens returned positive culture results in 3 patients (21%). Rotator cuff tears were noted in 8 patients (57%). Capsular contraction requiring release was noted in 2 patients (10%). In all patients, the diagnostic arthroscopy directed the next stage of management. Diagnostic arthroscopy allows a full assessment of implants, the rotator cuff, the native articular surfaces, and scar tissue, as well as biopsy specimens to be obtained for indolent infection, in patients considering revision arthroplasty surgery. This allows a more informative consent process for patients, directs surgical management, andon occasion, allows for therapeutic intervention in a painful or stiff shoulder arthroplasty.

Sleep Quality in Patients With Rotator Cuff Disease

Little is known about the influence of rotator cuff pathology on sleep. The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease. A nonrandomized, cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality. Data collected at time zero (before any treatment) included the Single Assessment Numeric Evaluation rating, the American Shoulder and Elbow Surgeons score, the Pittsburgh Sleep Quality Index, patient demographics, and medical comorbidities. Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance. Nocturnal pain was reported by 91% of the 391 participants (274 with tendinitis and 117 with rotator cuff tears). Participants had a mean age of 57 years. Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores (0.27 and 0.31; P = 0.004 and P < 0.0001, respectively), depression (0.27 and 0.30; P < 0.01), female sex (0.24 and 0.27; P < 0.001), presence of low back pain (0.25 and 0.27; P < 0.01), diabetes mellitus (0.24 in the rotator cuff tear group; P < 0.01), and increased body mass index (0.22 and 0.27; P = 0.02). The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index. These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity. Worse sleep quality scores in patients with rotator cuff disease are associated with pain, depression, female sex, low back pain, diabetes mellitus, and high body mass index. Overall, sleep quality did not differ among patients with varying rotator cuff disease severity. Only hypertension (in patients with rotator cuff tears) and concurrent cervical pathology (in patients with tendinitis) were uniquely related to the disease classification. Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease. Level III prognostic cohort study.

Initial experience with 18F-sodium fluoride (NaF) PET-CT: a viable functional biomarker in symptomatic Os acromiale.

Os acromiale (OA) is a failure of complete fusion of the acromial process. It is usually asymptomatic and discovered incidentally. OA can contribute to shoulder impingement symptoms and rotator cuff tears. 18F Sodium Fluoride (NaF) Positron Emission Tomography-CT (PET-CT) is an emerging and highly sensitive modality for oncological skeletal staging, and can show a variety of non-malignant uptake. We have analysed the relationship between 18F-NaF uptake in OA and associated symptoms of shoulder pain. Study population included 21 patients (mean age 60.2 ± 12years; 13 females and 8 males) with OA who underwent PET-CT scan by injecting 2.22MBqkg-1 of 18F-NaF. The relationship between 18F-NaF uptake and OA as a cause of pain was analysed. A 3-point grading system was used to evaluate uptake of 18F-NaF. In total 27 OA (12 symptomatic and 15 asymptomatic) were enrolled. All symptomatic OA showed focal increase tracer uptake of Grade 2, while asymptomatic OA did not have significant activity Grade 0 (n = 11) and Grade 1 (n = 4). 18F-NaF PET-CT appears to be a useful adjunct in the assessment of symptomatic OA with its particular strength being its high negative predictive value. Advances in knowledge: 18F-NaF PET-CT may be used as an ancillary tool for identifying symptomatic OA as a cause of shoulder pain in cases where other obvious causes of shoulder pain have been excluded.

Correlations of Neck/Shoulder Perfusion Characteristics and Pain Symptoms of the Female Office Workers with Sedentary Lifestyle.

AimModern office workers are often impacted by chronic neck/shoulder pain. Most of the previous studies which investigated the relationship of the occupational factors and musculoskeletal symptoms had adopted questionnaire survey. In this study the microcirculatory characteristics and perceived symptoms in neck/shoulder region were compared among office workers with sedentary lifestyle.MethodsThirty-seven female office workers were recruited in this study. Microcirculatory flow in neck/shoulder region characterized by the mean blood flow (MMBF value), pulsatile blood flow (PMBF value), and the PMBF/MMBF ratio (perfusion pulsatility, PP) were investigated using Laser Doppler Flowmetry (LDF). A Chinese version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ) were also administered to collect the information of perceived neck/shoulder symptoms. Correlations between the perfusion characteristics and the individual/occupational factors were analyzed using the Spearman test. The difference of the MMBF values between the low-pain group (pain level≤2) and the high-pain group (pain level>2) were compared using the Mann-Whitney U test.ResultsThere were 81% participants reported neck or shoulder pain symptoms. The duration of shoulder pain was significantly correlated with the workers’ age and the duration of employment (p<0.01) (n = 37). While both the MMBF and PMBF values in shoulder region were significantly reduced with the workers’ age and the duration of employment (p<0.05) (n = 27). And there was a 54% reduction in the MMBF value of the workers from age of 23 to 47. And the MMBF value of the high-pain group (n = 15) was significantly lower than the value of the low-pain group (n = 15) (p<0.05). The duration of shoulder pain showed a moderately negative correlation with PMBF values (n = 19). Besides, the PP value was moderately correlated with shoulder pain level attributed by the rapid reduction of MMBF values (p = 0.07).ConclusionIn this study, the LDF method was used for the first time in the workplace in Taiwan. It was demonstrated that the MMBF in shoulder region were affected by aging effect and towards lower value at higher pain level. Impaired microcirculation caused by age effect, when coupled with sedentary lifestyle, was found to be more likely to evoke ischemia shoulder pain. Further studies are needed to assess current indicator, PP value, and the underlying mechanism of pain caused by sedentary lifestyle.

Isolated Pectoralis Minor Release for Scapular Dyskinesis

Objectives:Pectoralis minor (PM) tightness has been linked to pain and dysfunction of the shoulder joint secondary to anterior tilt and internal rotation of the scapula, causing pseudo-impingement of the subacromial space. Most patients with pathologic tightness of the PM are treated successfully with non-operative treatment, yet a minority of patients experience persistent pain and dysfunction due to a pathologically tight PM. The purposes of this study are to describe the outcomes of operative release of PM tightness recalcitrant to nonoperative measures.Methods:Over a 3-year period, a total of 46 patients were enrolled (mean age 25.5, range 18 to 33) who presented with symptoms of shoulder pain, limited range of overhead motion, and inability to participate in overhead lifting activities, with examination consistent with primary abnormality of scapular dysfunction due to a tight PM with tenderness in the PM tendon. All patients underwent an extended period of physical therapy and stretching program (mean 11.4 months, range 5-23 months), and were followed with serial examinations for resolution of symptoms and scapular tilt. 6/46 (13%) patients were unable to adequately stretch the PM, and underwent isolated mini-open PM release. Outcomes were assessed with scapula protraction measurements, pain scales, and ASES and SANE score.Results:A total of 40/46 (87%) patients resolved the tight PM and scapular mediated symptoms with a dedicated therapy program (ASES 58 to 91; SANE 50 to 90, VAS 4.9 to 0.8, p<0.01). The 6/46 patients treated with isolated PM release demonstrated improvement in outcomes after failed nonoperative care (ASES 48 to 89; SANE 40 to 90.4; VAS 5.8 to 0.9, p<0.01). Overall, protraction of the scapula increased. The inferomedial scapular border was a mean of 1.2 cm from the chest wall preoperatively, and 0.3 cm postoperatively (p<0.01), similar to nonoperative responders. There were no complications and all those with isolated PM release returned to full or increased duties after release.Conclusion:In most patients, PM tightness can be successfully treated with non-operative management. However, in refractory pathologically tight PM cases, this series demonstrates predictable return to function with notable improvement in shoulder symptoms. Additional work is necessary to evaluate the long-term efficiency of isolated PM release.

Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder

Case report. Prognosis for adhesive capsulitis has been described as self-limiting and can persist for 1 to 3 years. Conservative treatment that includes physical therapy is commonly advised. The patient was a 54-year-old woman with primary symptoms of shoulder pain and loss of motion consistent with adhesive capsulitis. Manual physical therapy intervention initially consisted of joint mobilizations of the shoulder region and thrust manipulation of the cervicothoracic region. Although manual techniques seemed to result in some early functional improvement, continued progression was limited by pain. Subsequent examination identified trigger points in the upper trapezius, levator scapula, deltoid, and infraspinatus muscles, which were treated with dry needling to decrease pain and allow for higher grades of manual intervention. The patient was treated for a total of 13 visits over a 6-week period. After trigger point dry needling was introduced on the third visit, improvements in pain-free shoulder range of motion and functional outcome measures, assessed with the Shoulder Pain and Disability Index and the shortened form of the Disabilities of the Arm, Shoulder and Hand questionnaire, exceeded the minimal clinically important difference after 2 treatment sessions. At discharge, the patient had achieved significant improvements in shoulder range of motion in all planes, and outcome measures were significantly improved. This case report describes the clinical reasoning behind the use of trigger point dry needling in the treatment of a patient with adhesive capsulitis. The rapid improvement seen in this patient following the initiation of dry needling to the upper trapezius, levator scapula, deltoid, and infraspinatus muscles suggests that surrounding muscles may be a significant source of pain in this condition.

Comparison of Massage Based on the Tensegrity Principle and Classic Massage in Treating Chronic Shoulder Pain

ObjectiveThe purpose of this study was to compare the clinical outcomes of classic massage to massage based on the tensegrity principle for patients with chronic idiopathic shoulder pain. MethodsThirty subjects with chronic shoulder pain symptoms were divided into 2 groups, 15 subjects received classic (Swedish) massage to tissues surrounding the glenohumeral joint and 15 subjects received the massage using techniques based on the tensegrity principle. The tensegrity principle is based on directing treatment to the painful area and the tissues (muscles, fascia, and ligaments) that structurally support the painful area, thus treating tissues that have direct and indirect influence on the motion segment. Both treatment groups received 10 sessions over 2 weeks, each session lasted 20 minutes. The McGill Pain Questionnaire and glenohumeral ranges of motion were measured immediately before the first massage session, on the day the therapy ended 2 weeks after therapy started, and 1 month after the last massage. ResultsSubjects receiving massage based on the tensegrity principle demonstrated statistically significance improvement in the passive and active ranges of flexion and abduction of the glenohumeral joint. Pain decreased in both massage groups. ConclusionsThis study showed increases in passive and active ranges of motion for flexion and abduction in patients who had massage based on the tensegrity principle. For pain outcomes, both classic and tensegrity massage groups demonstrated improvement.

Your Livelihood

Large animal veterinarians face acute and chronic repetitive-strain injuries daily to their upper extremities. Symptoms of shoulder pain and arm weakness encompass at least 50 different diagnoses. This talk will identify and discuss the most common disabling conditions and provide insight into the complexity of the problem. Treatment, rehabilitation, and methods of preventing future disabilities will also be presented.

An Epidemiologic Survey of Shoulder Pain in Chiropractic Practice in Australia

Objective This survey investigated the demographic characteristics of the responding practitioners, the prevalence of shoulder pain symptoms seen in weekly chiropractic practice, the sources of shoulder pain, the chiropractor-diagnosed prevalence of shoulder clinical syndromes, and the management strategies for Australian chiropractors. Methods A survey was created by the authors consisting of questions seeking demographic information from the respondents, shoulder syndrome, and shoulder management information. The survey was mailed to every chiropractic practitioner based in the Australian state of New South Wales (general population 6.8 million in 2005). Contact details were derived from Yellow Pages online listings. Results One thousand thirty-seven surveys were mailed to New South Wales–based chiropractors, with 192 (21%) returning a completed survey. The prevalence of shoulder pain symptoms as reported by the practitioners was 12% of the total weekly patients, with the major cause of symptoms related to overuse (32%). The most prevalent working diagnosis of shoulder pain was shoulder impingement syndrome (13%), followed by impingement syndrome with rotator cuff tendinosis (17%), impingement syndrome without rotator cuff tendinosis (14%), and chiropractic shoulder subluxation (12%). Shoulder pain is managed with a combination of manipulation, mainly diversified technique (81%), peripheral joint manipulation (82%), and various soft tissue strategies used by 92% of practitioners. Rehabilitation strategies were also used by 89% of practitioners with a main emphasis placed on rotator cuff strengthening. Conclusion The results suggest a moderate prevalence of shoulder pain in clinical practice with the most prevalent structure involved being the rotator cuff tendon. Most practitioners use a multimodal therapeutic treatment approach in managing disorders of the shoulder.

견비통 환자에 대한 한방단독치료와 한.양방병행치료의 치료효과 비교 연구

Objectives This study is for comparing the results in two groups of using Oriental medical treatment only with using Oriental-Western medical treatment together to shoulder pain patients. Methods 49 shoulder pain patients who participated in the clinical study both at the Bukpyeoung Haemalkeun Oriental Medical Clinic and at the Bukpyeoung Medical Clinic in Donghae city were classified 2 groups. Group A was treated with Oriental medical therapy only and group B was treated with Oriental-Western medical treatment together. They have been treated 3 times a week for 4 weeks. Results After 1, 2 and 4 weeks of each treatment, the scores of the two groups in `Subjective symptoms of shoulder pain`, `Indisposition index of every day life`, `Shoulder pain and disability index`, `Visual analog scale` became signific antly lower than those before treatment. Conclusion Treatment of group B was better than treatment of group A but, there was no significant difference in therapeutic action between two groups.

The anatomy of the quadrilateral space with reference to quadrilateral space syndrome

Quadrilateral space syndrome is a rare condition in which the contents of the quadrilateral space, the axillary nerve and the posterior circumflex humeral artery, are compressed, leading to vague symptoms of shoulder pain, tenderness over the quadrilateral space on palpation, and teres minor and deltoid denervation. Fibrous bands within the quadrilateral space are often cited in the literature as a cause of compression in quadrilateral space syndrome; however, Cahill and Palmer did not see these bands in cadaveric dissection. These are postulated to cause compression of the quadrilateral space contents in abduction and external rotation of the shoulder. To clarify the anatomic features that may predispose the development of quadrilateral space syndrome, 16 cadaveric shoulders were studied. Dissection revealed that fibrous bands are a common finding in the quadrilateral space, being present in 14 of 16 shoulders. The most common site for a fibrous band was between the teres major and the long head of the triceps. Where the bands were present, both internal and external rotation of the shoulder caused a reduction in the cross-sectional area of the quadrilateral space.

Rotator cuff tendonitis in lymphedema: A retrospective case series

Herrera JE, Stubblefield MD. Rotator cuff tendonitis in lymphedema: a retrospective case series. Objectives To report rotator cuff tendonitis as a complication of lymphedema and to discuss the possible etiology and treatment options. Design Retrospective review of 8 cases. Setting University hospital outpatient clinic. Participants A total of 8 breast cancer patients with a history of lymphedema and ipsilateral shoulder pain. Intervention Patients with lymphedema and ipsilateral shoulder pain were diagnosed with rotator cuff tendonitis if all of the following 3 tests were positive: supraspinatus test, Neer’s impingement test, and Hawkin’s impingement test. Patients diagnosed with rotator cuff tendonitis were prescribed a nonsteriodal anti-inflammatory drug (NSAID) and physical therapy (PT). Main outcome measures Improvement in symptoms of shoulder pain at a 4- to 6-week follow-up, as measured by visual analog scale (VAS). Results Seven of 8 patients reported a subjective decrease in their symptoms of shoulder pain at a 4- to 6-week follow-up. The average improvement in shoulder pain as measured by VAS was a 4.5-point decrease from the original pain score given. One of 8 patients had a full-thickness supraspinatus tendon tear and required additional decongestive therapy and PT to obtain relief of symptoms. Conclusions Rotator cuff tendonitis is a complication of lymphedema caused by internal derangement of tendon fibers, which may be subject to impingement, functional overload, and intrinsic tendinopathy. Conservative treatment with NSAIDs and PT is a safe and effective treatment.