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Gutiérrez-Espinoza H, Estrella-Flores E, Cuyul-Vásquez I, Jorquera-Aguilera R, Francisco López-Gil J, Araya-Quintanilla F. Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study. J Sport Rehabil 2024; 33:106-113. [PMID: 38167648 DOI: 10.1123/jsr.2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/30/2023] [Accepted: 10/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. METHODS A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. RESULTS A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). CONCLUSION At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.
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Affiliation(s)
| | | | - Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | | | | | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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The Effect of Scapular Muscle Strengthening on Functional Recovery in Patients With Lateral Elbow Tendinopathy: A Pilot Randomized Controlled Trial. J Sport Rehabil 2021; 30:744-753. [PMID: 33440342 DOI: 10.1123/jsr.2020-0203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/09/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT There is a lack of consensus on the best management approach for lateral elbow tendinopathy (LET). Recently, scapular stabilizer strength impairments have been found in individuals with LET. OBJECTIVE The purpose of this study was to compare the effectiveness of local therapy (LT) treatment to LT treatment plus a scapular muscle-strengthening (LT + SMS) program in patients diagnosed with LET. DESIGN Prospective randomized clinical trial. SETTING Multisite outpatient physical therapy. PATIENTS Thirty-two individuals with LET who met the criteria were randomized to LT or LT + SMS. INTERVENTIONS Both groups received education, a nonarticulating forearm orthosis, therapeutic exercise, manual therapy, and thermal modalities as needed. Additionally, the LT + SMS group received SMS exercises. MAIN OUTCOME MEASURE The primary outcome measure was the patient-rated tennis elbow evaluation; secondary outcomes included global rating of change (GROC), grip strength, and periscapular muscle strength. Outcomes were reassessed at discharge, 6, and 12 months from discharge. Linear mixed-effect models were used to analyze the differences between groups over time for each outcome measure. RESULTS The average duration of symptoms was 10.2 (16.1) months, and the average total number of visits was 8.0 (2.2) for both groups. There were no significant differences in gender, age, average visits, weight, or height between groups at baseline (P > .05). No statistical between-group differences were found for any of the outcome measures. There were significant within-group improvements in all outcome measures from baseline to all follow-up points (P < .05). CONCLUSION The results of this pilot study suggest that both treatment approaches were equally effective in reducing pain, improving function, and increasing grip strength at discharge as well as the 6- and 12-month follow-ups. Our multimodal treatment programs were effective at reducing pain and improving function up to 1 year after treatment in a general population of individuals with LET.
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Rysstad T, Røe Y, Haldorsen B, Svege I, Strand LI. Responsiveness and minimal important change of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in patients with subacromial pain syndrome. BMC Musculoskelet Disord 2017; 18:248. [PMID: 28595612 PMCID: PMC5465524 DOI: 10.1186/s12891-017-1616-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/02/2017] [Indexed: 12/20/2022] Open
Abstract
Background The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) is a valid and reliable patient-reported outcome measure (PROM). It was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity, and is one of the most commonly used PROMs for patients with shoulder pain. The aim of this study was to examine responsiveness, the smallest detectable change (SDC) and the minimal important change (MIC) of the DASH, in line with international (COSMIN) recommendations. Methods The study sample consisted of 50 patients with subacromial pain syndrome, undergoing physical therapy for 3–4 months. Responsiveness to change was examined by calculating area under the receiver operating characteristic curves (AUC) and testing a priori-formulated hypothesis regarding correlations with changes in other instruments that measuring the same construct. The SDC was calculated using a test re-test protocol, and the MIC was calculated by the anchor-based MIC distribution. MIC values for patients with low and high baseline scores were also calculated. Results DASH appeared to be responsive, as it was able to distinguish patients who reported to be improved from those unchanged (AUC 0.77). All of the hypotheses were accepted. The SDC was 11.8, and the MIC was 4.4. Conclusion This study shows that the Norwegian version of the DASH has good responsiveness to change and may thus be recommended to measure outcome in patients with shoulder pain in Norway.
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Affiliation(s)
- Tarjei Rysstad
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St Olavs Plass, Oslo, Norway.
| | - Yngve Røe
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St Olavs Plass, Oslo, Norway
| | | | - Ida Svege
- Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Yoshii Y, Yuine H, Kazuki O, Tung WL, Ishii T. Measurement of wrist flexion and extension torques in different forearm positions. Biomed Eng Online 2015; 14:115. [PMID: 26830913 PMCID: PMC4676844 DOI: 10.1186/s12938-015-0110-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 11/28/2015] [Indexed: 11/15/2022] Open
Abstract
Background Forceful activities of the wrist were considered to be a risk factor for the epicondylitis. However, there are still conflicting evidence concerning work-relatedness of epicondylitis. The main problem is that there is little information about which forearm postures are capable of withstanding higher torque loads and the extent of the differences in the torques generated by different forearm postures. The objective of this study was to investigate the differences in wrist flexion and extension torques among different forearm positions in healthy subjects. Methods Twenty wrists of 10 asymptomatic volunteers were evaluated. The apparatus to measure the wrist torque consisted of a handle with a force sensor and a table to place the forearm in different positions. The direction of the handle can change when measuring different forearm positions. The forearm of the examinee was secured to the table. The participants were asked to exert themselves in maximal isometric contraction for wrist flexion or extension, and to maintain it for 5 s. Each evaluation of the flexion and extension torque was conducted twice. Three forearm positions were evaluated: neutral, pronation, and supination. The intra-class correlation coefficients between first and second measurements were evaluated for the maximum torque. The maximum torques and flexion/extension ratio were compared among the positions. In addition, the agility and endurance for the wrist extension/flexion torques were compared among the positions. Results The intra-class correlation coefficients between first and second measurements were 0.928 and 0.866 for the wrist flexion and extension measurements, respectively. The highest torques for the wrist flexion and extension were observed in the supination and pronation positions, respectively (P < 0.01). There was a higher extension/flexion ratio in the supination position compared to the other positions (P < 0.05). There was a superior agility for the wrist flexion in the supination position compared to the pronation position. Conclusions The normal balance of the wrist flexion–extension torques in different forearm positions were characterized. This information might aid the provision of advice regarding the optimal positions for performing specific tasks and could help to elucidate the pathophysiology of epicondylitis.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Hiroshi Yuine
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Ohashi Kazuki
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Wen-Lin Tung
- Department of Rehabilitation, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan.
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
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Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, Shishido H, Fukuhara S, Kikuchi S, Konno S. Chronic hyperglycemia increases the risk of lateral epicondylitis: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). SPRINGERPLUS 2015; 4:407. [PMID: 26266078 PMCID: PMC4530269 DOI: 10.1186/s40064-015-1204-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/31/2015] [Indexed: 12/03/2022]
Abstract
Background Although humeral epicondylitis is a common health problem, there have been no reports that describe its prevalence in Japanese general population, and relatively little is known about its etiology and associated risk factors. Questions/purposes This study aimed to clarify the prevalence of humeral epicondilitis in Japanese general population, and investigate the associated risk factors using the data from a cross-sectional study of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). Methods A total of 1,777 participants who participated in health checkups conducted at rural area in Japan in 2010 were enrolled. The prevalence of lateral and medial epicondylitis was investigated. Logistic regression models were performed to examine the relationship between lateral epicondylitis and correlated factors such as occupational status, smoking and alcohol preferences, and medical characteristics. Results The overall prevalence of lateral and medial epicondylitis was 2.5 % and 0.3 %, respectively. A shortened version of the disabilities of the arm, shoulder and hand (The QuickDASH) score was significantly higher in subjects with lateral epicondylitis than in those without (15.0 ± 12.7 vs 8.5 ± 11.1). Subjects with definite chronic hyperglycemia (HbA1c ≥ 6.5) showed a 3.37-times higher risk of lateral epicondylitis than those with favorable glycemic control (HbA1c < 5.5) (95 % confidence interval (CI) 1.16–8.56). Age and sex, as well as occupational status, smoking and alcohol preference, and other metabolic factors were not significantly related to higher risk of lateral epicondylitis. Conclusions Lateral epicondylitis influences activities of daily living. Chronic hyperglycemia might be one of the risk factor for lateral epicondylitis. Clinical relevance Chronic hyperglycemia is significantly associated with lateral epicondylitis.
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Affiliation(s)
- Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita City, Osaka 565-8565 Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), 513, Nijosagaruakinonomachi, Karasumadori, Chukyoku, Kyoto City, Kyoto 604-084 Japan
| | - Shin Yamazaki
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
| | - Hiroaki Shishido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Shinichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima City, Fukushima 960-1295 Japan
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Titchener AG, White JJE, Hinchliffe SR, Tambe AA, Hubbard RB, Clark DI. Comorbidities in rotator cuff disease: a case-control study. J Shoulder Elbow Surg 2014; 23:1282-8. [PMID: 24618192 DOI: 10.1016/j.jse.2013.12.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff disease is a common condition in the general population, but relatively little is known about its associated risk factors. MATERIALS AND METHODS We have undertaken a large case-control study using The Health Improvement Network database to assess and to quantify the relative contributions of some constitutional and environmental risk factors for rotator cuff disease in the community. Our data set included 5000 patients with rotator cuff disease who were individually matched with a single control by age, sex, and general practice (primary care practice). RESULTS The median age at diagnosis was 55 years (interquartile range, 44-65 years). Multivariate analysis showed that the risk factors associated with rotator cuff disease were Achilles tendinitis (odds ratio [OR] = 1.78), trigger finger (OR = 1.99), lateral epicondylitis (OR = 1.71), and carpal tunnel syndrome (OR = 1.55). Oral corticosteroid therapy (OR = 2.03), oral antidiabetic use (OR = 1.66), insulin use (OR = 1.77), and "overweight" body mass index of 25.1 to 30 (OR = 1.15) were also significantly associated. Current or previous smoking history, body mass index of greater than 30, any alcohol intake, medial epicondylitis, de Quervain syndrome, cubital tunnel syndrome, and rheumatoid arthritis were not found to be associated with rotator cuff disease. CONCLUSIONS We have identified a number of comorbidities and risk factors for rotator cuff disease. These include lateral epicondylitis, carpal tunnel syndrome, trigger finger, Achilles tendinitis, oral corticosteroid use, and diabetes mellitus. The findings should alert the clinician to comorbid pathologic processes and guide future research into the etiology of this condition.
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Affiliation(s)
| | | | | | - Amol A Tambe
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
| | - Richard B Hubbard
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - David I Clark
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
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Bodin J, Ha C, Petit A, Descatha A, Thomas T, Goldberg M, Leclerc A, Roquelaure Y. Natural course of rotator cuff syndrome in a French working population. Am J Ind Med 2014; 57:683-94. [PMID: 24585691 DOI: 10.1002/ajim.22315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim was to assess the persistence of rotator cuff syndrome (RCS) in workers and to study associations with personal and work-related factors, job change, exposure change and treatment. METHODS At baseline, 274 workers suffered from RCS, of whom 150 were followed up. Three groups were constituted: (1) a RCS recovery group, (2) a shoulder pain without RCS group, and (3) a RCS without recovery group. We studied the differences between groups (1) and (3) because of the low number of workers in group (2). RESULTS Recovery occurred in 61.5% of men and 51.4% of women. Factors related to work were associated with persistence of RCS in men whereas upper limb pain and absence of job rotation were associated with persistence of RCS in women. CONCLUSION This descriptive study showed that a high percentage of workers recovered and several personal and work-related factors were associated with persistent RCS. Larger prospective studies are needed to confirm these results.
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Affiliation(s)
- Julie Bodin
- LUNAM Université; Université d'Angers; Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST); Angers France
| | - Catherine Ha
- Département santé travail; Institut de veille sanitaire; Saint-Maurice France
| | - Audrey Petit
- LUNAM Université; Université d'Angers; Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST); Angers France
- CHU Angers; Angers France
| | - Alexis Descatha
- Université de Versailles St-Quentin; UMRS 1018; Population-Based Epidemiological Cohorts' Research Platform; Villejuif France
| | - Thierry Thomas
- CHU Saint-Étienne; Service de Rhumatologie; Saint-Étienne France
| | - Marcel Goldberg
- Université de Versailles St-Quentin; UMRS 1018; Population-Based Epidemiological Cohorts' Research Platform; Villejuif France
| | - Annette Leclerc
- Université de Versailles St-Quentin; UMRS 1018; Population-Based Epidemiological Cohorts' Research Platform; Villejuif France
| | - Yves Roquelaure
- LUNAM Université; Université d'Angers; Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST); Angers France
- CHU Angers; Angers France
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Hegmann KT, Thiese MS, Wood EM, Garg A, Kapellusch JM, Foster J, Biggs J, Edwards H, Wertsch J, Kendall R. Impacts of differences in epidemiological case definitions on prevalence for upper-extremity musculoskeletal disorders. HUMAN FACTORS 2014; 56:191-202. [PMID: 24669553 DOI: 10.1177/0018720813487202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to systematically evaluate prevalence based on variations in case definitions used for epidemiological studies of musculoskeletal disorders (MSDs). BACKGROUND Prior studies of MSDs have mostly relied on a single case definition based on questionnaires. METHOD In a multicenter prospective cohort study, we systematically collected data to evaluate impacts of differences in case definitions of MSDs on prevalence of three common musculoskeletal disorders: (a) shoulder tendinosis, (b) lateral epicondylalgia, and (c) carpal tunnel syndrome. Production workers were from 21 employment settings in three diverse U.S. states and performed widely varying work. All workers completed laptop-administered structured interviews, two standardized physical examinations, and nerve conduction studies (NCS). Case definitions included symptoms only, and symptoms plus physical examinations and/or NCS. RESULTS A total of 1,227 subjects had complete health data at baseline. The prevalence for shoulder tendinosis is 23.0% if only glenohumeral pain is used for a case definition, compared with 8.0% if a combination of pain plus a positive supraspinatus test is used. The prevalence for lateral epicondylalgia varied on the basis of lateral elbow pain (12.0%), pain plus tenderness on palpation (9.9%), or pain plus tenderness on palpation plus resisted wrist or middle finger extension (3.5%). Carpal tunnel syndrome prevalence varied on the basis of tingling or numbness in a median nerve-served digit (29.9%) or tingling or numbness plus NCS abnormalities consistent with carpal tunnel syndrome (9.0%). CONCLUSION Variations in epidemiological case definitions have major impacts on prevalence of common MSDs. Wide-ranging differences in prevalence may have impacts on purported risk factors that need to be determined.
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Rol Y, Haldorsen B, Svege I, Bergland A. Development and reliability of a clinician-rated instrument to evaluate function in individuals with shoulder pain: a preliminary study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2013; 18:230-8. [PMID: 23716317 PMCID: PMC4286020 DOI: 10.1002/pri.1555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 09/05/2012] [Accepted: 04/05/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Subacromial impingement syndrome (SIS) is a common and disabling condition in the population. Interventions are often evaluated with patient-rated outcome measures. The purpose of this study was to develop a simple clinician-rated measure to detect difficulties in the execution of movement-related tasks among patients with subacromial impingement syndrome. METHOD The steps in the scale development included a review of the clinical literature of shoulder pain to identify condition-specific questionnaires, pilot testing, clinical testing and scale construction. Twenty-one eligible items from thirteen questionnaires were extracted and included in a pilot test. All items were scored on a five-point ordinal scale ranging from 1 (no difficulty) to 5 (cannot perform). Fourteen items were excluded after pilot testing because of difficulties in standardization or other practical considerations. The remaining seven items were included in a clinical test-retest study with outpatients at a hospital. Of these, four were excluded because of psychometric reasons. From the remaining three items, a measure named Shoulder Activity Scale (summed score ranging from 3 to 15) was developed. RESULTS A total of 33 men and 30 women were included in the clinical study; age range 27-80 years. The intraclass correlation coefficient results for inter-rater reliability and test-retest reliability were 0.80 (95% CI = 0.51-0.90) and 0.74 (95% CI = 0.58-0.84), respectively. The standard error of measurement and minimal detectable change were 1.19 and 3.32, respectively. The scale was linked to the International Classification of Functioning, Disability and Health second level categories lifting and carrying objects (d430), dressing (d540), hand and arm use (d445) and control of voluntary movement (b760). CONCLUSION The Shoulder Activity Scale showed acceptable reliability in a sample of outpatients at a hospital, rated by clinicians experienced in shoulder rehabilitation. The validity of the scale should be investigated in future studies before application to common practice. © 2013 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.
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Affiliation(s)
- Yngve Rol
- Faculty of Health Sciences, Oslo and Akershus University College of Applied SciencesOslo, Norway
| | | | - Ida Svege
- Norwegian research center for Active Rehabilitation (NAR)Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo and Akershus University College of Applied SciencesOslo, Norway
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Lucado AM, Kolber MJ, Cheng MS, Echternach JL. Subacromial impingement syndrome and lateral epicondylalgia in tennis players. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328810x12647087219036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chan S, Hill R, Kerr J. Passive joint mobilisation: does it enhance outcome of adhesive capsulitis of the shoulder following corticosteroid injection? ACTA ACUST UNITED AC 2013. [DOI: 10.1179/175361410x12652805807594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Upper extremity strength characteristics in female recreational tennis players with and without lateral epicondylalgia. J Orthop Sports Phys Ther 2012; 42:1025-31. [PMID: 22960729 DOI: 10.2519/jospt.2012.4095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Descriptive, cross-sectional. OBJECTIVES To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. BACKGROUND There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. METHODS Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (STP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. RESULTS The STP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The STP group had weaker lower trapezius strength (mean difference, -9.0 N; 95% confidence interval [CI]: -13.5, -4.4) and wrist extensor strength (-12.7 N; 95% CI: -24.4, -1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the STP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). CONCLUSION In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest.
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Holm JW, Hartvigsen J, Lings S, Kyvik KO. Modest associations between self-reported physical workload and neck trouble: a population-based twin control study. Int Arch Occup Environ Health 2012; 86:223-31. [PMID: 22426540 DOI: 10.1007/s00420-012-0755-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 02/29/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the relationship between self-reported physical workload and neck trouble (NT) in twins. Additionally, to explore whether the relationship between physical workload and NT is influenced by genetic factors. METHODS A twin control study was performed within a population-based, cross-sectional questionnaire study using 3,208 monozygotic (MZ) and same-sexed dizygotic (DZ) twins aged 19-70. Twin pairs discordant for self-reported NT during the past year ("Any NT") were included. Self-reported physical workload in four categories was used as exposure ("sitting," "sitting and walking," "light physical," and "heavy physical" work). Paired analyses including conditional logistic regression were made for all participants and for each sex, and MZ and DZ pairs separately. RESULTS No marked associations between physical workload and NT were seen. A moderate risk elevation in "heavy physical" work was seen in DZ men (odds ratio 2.3, 95% confidence intervals 1.3-4.0), but not in MZ men or the MZ or DZ women. CONCLUSIONS The findings in some degree supported that "heavy physical" work is a determinant of NT, perhaps only in men, but hardly of any greater importance. The different results between DZ and MZ men suggest that genetic factors influence the relationship between physical workload and NT.
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Calfee RP, Dale AM, Ryan D, Descatha A, Franzblau A, Evanoff B. Performance of simplified scoring systems for hand diagrams in carpal tunnel syndrome screening. J Hand Surg Am 2012; 37:10-7. [PMID: 21975100 PMCID: PMC3438892 DOI: 10.1016/j.jhsa.2011.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Katz et al have published a standardized scoring system of hand diagrams for carpal tunnel syndrome. The purpose of this study was to quantitatively evaluate an alternative scoring of the hand diagram for detection of carpal tunnel syndrome. METHODS In a prospective study of 1,107 workers, 221 workers with hand symptoms completed hand diagrams and electrodiagnostic testing for carpal tunnel syndrome. Scoring algorithms for the hand diagrams included the Katz rating; a median nerve digit score (0-2) with a maximum of 2 symptomatic digits of thumb, index, and long fingers; and isolated digit scores (0-1) of thumb, index, or long finger. Intraclass correlation coefficients quantified inter-rater reliability. Sensitivity, specificity, and logistic regression analyses evaluated the scoring systems' ability to predict abnormal median nerve conduction. RESULTS One hundred ten subjects illustrated symptoms within the median nerve distribution. All scoring systems demonstrated substantial inter-rater reliability. "Classic" or "probable" Katz scores, median nerve digit score of 2, and positive long finger scores were significantly associated with abnormal median nerve distal sensory latency and median-ulnar difference. Abnormal distal motor latency was significantly associated with the median nerve digit score of 2 and positive long finger scores. Increasing Katz scores from "possible" to "probable" and "classic" were not associated with greater odds of electrodiagnostic abnormality. Positive long finger scores performed at least as well as the most rigorous scoring by Katz. CONCLUSIONS Symptoms diagrammed within the median nerve distribution are associated with abnormal nerve conduction among workers. The median nerve digit score and the long finger score offer increased ease of use compared to the Katz method, while maintaining similar performance characteristics. The long finger appears best suited for isolated digit scoring to predict abnormal median nerve conduction in a working population. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Ryan P. Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ann Marie Dale
- Department of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Ryan
- Department of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Alexis Descatha
- Department of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA,University of Versailles-Saint Quentin (UVSQ), Poincaré Teaching Hospital AP-HP, Occupational health department, INSERM U1018, Garches, France
| | - Alfred Franzblau
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Bradley Evanoff
- Department of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Amirfeyz R, Mehendale S, Tyrrell S, Bhatia R, Leslie I, Bannister G. KATZ AND STIRRAT HAND DIAGRAM REVISITED. ACTA ACUST UNITED AC 2011; 15:71-3. [DOI: 10.1142/s0218810410004667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/12/2010] [Accepted: 04/06/2010] [Indexed: 11/18/2022]
Abstract
Katz and Stirrat devised a hand diagram, which uses subjective information from the patient for the diagnosis of carpal tunnel syndrome (CTS). They reported a good result. We tested the inter-observer and intra-observer reliability of this hand diagram. Twenty five consecutive patients with a diagnosis of CTS, 25 with other common hand and wrist problems but CTS and 25 healthy individuals were prospectively recruited. Each patient filled in a hand diagram. Two experienced hand surgeon scored the diagrams blindly on two different sittings four-week apart. The intra-class correlation coefficient (ICC) and Cohen's Kappa were used for intra and inter-observer reliability respectively. The intra-observer agreement was poor (ICC 95% 0.33–0.65) and inter-observer was fair (Kappa = 0.241). This study does not support the use of Katz and Stirrat Hand Diagram for the diagnosis of carpal tunnel syndrome in place if a thorough clinical examination.
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Affiliation(s)
- Rouin Amirfeyz
- Trauma and Orthopaedic Department, British Royal Infirmary, Bristol, UK
| | | | | | - Raj Bhatia
- Trauma and Orthopaedic Department, British Royal Infirmary, Bristol, UK
| | - Ian Leslie
- Trauma and Orthopaedic Department, British Royal Infirmary, Bristol, UK
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Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford) 2011; 51:305-10. [PMID: 22019808 DOI: 10.1093/rheumatology/ker228] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore the relationship between occupational exposures and lateral and medial epicondylitis, and the effect of epicondylitis on sickness absence in a population sample of working-aged adults. METHODS This was a cross-sectional study of 9696 randomly selected adults aged 25-64 years involving a screening questionnaire and standardized physical examination. Age- and sex-specific prevalence rates of epicondylitis were estimated and associations with occupational risk factors explored. RESULTS Among 6038 respondents, 636 (11%) reported elbow pain in the last week. Of those surveyed, 0.7% were diagnosed with lateral epicondylitis and 0.6% with medial epicondylitis. Lateral epicondylitis was associated with manual work [odds ratio (OR) 4.0, 95% CI 1.9, 8.4]. In multivariate analyses, repetitive bending/straightening elbow >1 h day was independently associated with lateral (OR 2.5, 95% CI 1.2, 5.5) and medial epicondylitis (OR 5.1, 95% CI 1.8, 14.3). Five per cent of adults with epicondylitis took sickness absence because of their elbow symptoms in the past 12 months (median 29 days). CONCLUSION Repetitive exposure to bending/straightening the elbow was a significant risk factor for medial and lateral epicondylitis. Epicondylitis is associated with prolonged sickness absence in 5% of affected working-aged adults.
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Affiliation(s)
- Karen Walker-Bone
- Department of Rheumatology, Brighton and Sussex Medical School, Princess Royal Hospital, Haywards Heath, West Sussex, UK.
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17
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Inter-rater reliability of physical examinations in a prospective study of upper extremity musculoskeletal disorders. J Occup Environ Med 2011; 52:1014-8. [PMID: 20881623 DOI: 10.1097/jom.0b013e3181f4396b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To test the inter-rater reliability of physical examinations for upper extremity musculoskeletal disorders. METHODS A total of 111 subjects were examined by both an occupational medicine physician and a physical therapist, who were blinded to each others' tests results and subjects' current symptoms and health histories. RESULTS Inter-rater reliability was moderate to excellent (0.52 to 0.88) for shoulder tests but required the inclusion of symptoms for increased inter-rater reliability of fair to excellent (0.27 to 0.57) for the elbow and hand/wrist tests. CONCLUSIONS With the lack of "gold standard" tests, it is important that epidemiologic field studies conduct and report inter-rater reliability testing results between study examiners. It is important for researchers to report the results of inter-rater reliability, so that practitioners can weigh the results of study findings to improve both their diagnosis and treatment of these costly injuries.
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18
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Lateral and medial epicondylitis: Role of occupational factors. Best Pract Res Clin Rheumatol 2011; 25:43-57. [DOI: 10.1016/j.berh.2011.01.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/24/2010] [Accepted: 01/25/2011] [Indexed: 11/23/2022]
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Keijsers E, Feleus A, Miedema HS, Koes BW, Bierma-Zeinstra SMA. Psychosocial factors predicted nonrecovery in both specific and nonspecific diagnoses at arm, neck, and shoulder. J Clin Epidemiol 2011; 63:1370-9. [PMID: 20430579 DOI: 10.1016/j.jclinepi.2010.01.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/17/2009] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the differences in predictors of nonrecovery between patients with a specific diagnosis at arm, neck, and/or shoulder, vs. patients with a nonspecific diagnosis in general practice at 6 months after the first consultation. STUDY DESIGN AND SETTING New consulters with nontraumatic arm, neck, or shoulder complaints entered the cohort. Patient, complaint, and physical, psychosocial, and work characteristics were evaluated as possible predictors. Logistic regression analyses were conducted for the specific and nonspecific groups separately. RESULTS At 6 months, 38% (n=298) of the specific-group members and 49% (n=249) of the nonspecific-group members reported nonrecovery. Univariately, similar variables were related in both groups, although their strength sometimes differed. Multivariately, duration of complaints was predictive of nonrecovery in both groups. Other predictors in the specific group were as follows: more somatization, low social support, older age, high body mass index, and unemployment. In the nonspecific group, the predictors were as follows: musculoskeletal comorbidity, recurrent complaint, poor perceived general health, multiple-region complaints, and high level of kinesiophobia. CONCLUSION At 6 months, nonrecovery was reported more frequently in the group of patients with a nonspecific diagnosis. The predictive value of psychosocial factors on nonrecovery is at least of equal importance in patients with a specific diagnosis compared with patients with a nonspecific diagnosis.
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Affiliation(s)
- Ellen Keijsers
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Roquelaure Y, Ha C, Touranchet A, Descatha A, Bidron P, Lendevic B, Leroux F, Mazoyer A, Méritet F, Goldberg M, Imbernon E. Utilisation du protocole de surveillance en entreprise : expérience du programme de surveillance épidémiologique des TMS dans les Pays de la Loire. ARCH MAL PROF ENVIRO 2010. [DOI: 10.1016/j.admp.2010.03.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elfar JC, Calfee RP, Stern PJ. Topographical assessment of symptom resolution following open carpal tunnel release. J Hand Surg Am 2009; 34:1188-92. [PMID: 19643551 PMCID: PMC4422642 DOI: 10.1016/j.jhsa.2009.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 04/15/2009] [Accepted: 04/15/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with carpal tunnel syndrome commonly present with paresthesias and pain extending into the small finger and proximal to the hand. This study was conducted to assess the ability of carpal tunnel release to relieve symptoms outside of the median nerve distribution. METHODS We enrolled 34 consecutive surgical patients (40 wrists) diagnosed exclusively with carpal tunnel syndrome based on the history, physical examination, and electrodiagnostic studies. Preoperative symptoms were categorized as pain, numbness, tingling, or "burning and electrical shocks." The presence or absence of each symptom type was recorded in 5 topographical areas (zone I, palmar thumb/index/long; zone II, small finger; zone III, volar forearm; zone IV, volar arm; and zone V, dorsal hand/forearm/arm). Patients were contacted at 4 to 6 weeks postoperatively to assess resolution of each symptom type by topographic zone. RESULTS Preoperatively, the cohort reported symptoms in all zones: zone I, 120 reports; zone II, 47 reports; zone III, 33 reports; zone IV, 7 reports; and zone V, 23 reports. Numbness (n = 40) and tingling (n = 38) were the most common symptoms, followed by pain (n = 29) and "burning/shocks" (n = 16). Postoperatively, the total number of reports within the 5 zones decreased from 230 to 20. The probability that surgery would eliminate patient symptoms was 88% (104 of 120) in zone I, 96% (45 of 47) in zone II, 97% (32 of 33) in zone III, 86% (6 of 7) in zone 4, and 100% (23 of 23) in zone V. Across zones, the overall probability of symptom resolution was as follows: pain > 80%, numbness/tingling > 85%, and "burning/shocks" > 90%. CONCLUSIONS Symptoms experienced outside of the median nerve distribution had a high likelihood of resolution after carpal tunnel release. Over 85% of symptoms in each of the anatomic zones studied resolved. Feelings of burning or shock-like sensations were most reliably relieved at early follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Ryan P. Calfee
- Washington University School of Medicine, Department of Orthopedic Surgery, Division of Hand Surgery
| | - Peter J. Stern
- Hand Surgery Specialists, Inc., University of Cincinnati, Department of Orthopedic Surgery, Division of Hand Surgery
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22
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Adhesive capsulitis: establishing consensus on clinical identifiers for stage 1 using the DELPHI technique. Phys Ther 2009; 89:906-17. [PMID: 19589853 DOI: 10.2522/ptj.20080341] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adhesive capsulitis often is difficult to diagnose in its early stage and to differentiate from other commonly seen shoulder disorders with the potential to cause pain and limited range of movement. OBJECTIVES The purpose of this study was to establish consensus among a group of experts regarding the clinical identifiers for the first or early stage of primary (idiopathic) adhesive capsulitis. DESIGN A correspondence-based Delphi technique was used in this study. METHODS Three sequential questionnaires, each building on the results of the previous round, were used to establish consensus. RESULTS A total of 70 experts from Australia and New Zealand involved in the diagnosis and treatment of adhesive capsulitis completed the 3 rounds of questionnaires. Following round 3, descriptive statistics were used to screen the data into a meaningful subset. Cronbach alpha and factor analysis then were used to determine agreement among the experts. Consensus was achieved on 8 clinical identifiers. These identifiers clustered into 2 discrete domains of pain and movement. For pain, the clinical identifiers were a strong component of night pain, pain with rapid or unguarded movement, discomfort lying on the affected shoulder, and pain easily aggravated by movement. For movement, the clinical identifiers included a global loss of active and passive range of movement, with pain at the end-range in all directions. Onset of the disorder was at greater than 35 years of age. CONCLUSIONS This is the first study to use the Delphi technique to establish clinical identifiers indicative of the early stage of primary (idiopathic) adhesive capsulitis. Although limited in differential diagnostic ability, these identifiers may assist the clinician in recognizing early-stage adhesive capsulitis and may inform management, as well as facilitate future research.
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Boocock M, Collier J, McNair P, Larmer P. Comment on: Letter to the Editor from Miedema HS and Huisstede BMA⁎⁎Semin Arthrit Rheum 2009;38:407-408 (this issue). Semin Arthritis Rheum 2009. [DOI: 10.1016/j.semarthrit.2008.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boocock MG, Collier JM, McNair PJ, Simmonds M, Larmer PJ, Armstrong B. A Framework for the Classification and Diagnosis of Work-Related Upper Extremity Conditions: Systematic Review. Semin Arthritis Rheum 2009; 38:296-311. [DOI: 10.1016/j.semarthrit.2007.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/04/2007] [Accepted: 10/21/2007] [Indexed: 11/28/2022]
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25
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Burton AK, Kendall NAS, Pearce BG, Birrell LN, Bainbridge LC. Management of work-relevant upper limb disorders: a review. Occup Med (Lond) 2008; 59:44-52. [PMID: 19073992 DOI: 10.1093/occmed/kqn151] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management. AIM To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate. METHODS Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses. RESULTS Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be on side and acting in a coordinated fashion; this requires engaging employers and workers to participate. CONCLUSIONS The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift.
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Affiliation(s)
- A Kim Burton
- Centre for Health and Social Care Research, University of Huddersfield, Huddersfield, UK.
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26
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Schellingerhout JM, Verhagen AP, Thomas S, Koes BW. Lack of uniformity in diagnostic labeling of shoulder pain: Time for a different approach. ACTA ACUST UNITED AC 2008; 13:478-83. [DOI: 10.1016/j.math.2008.04.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 03/18/2008] [Accepted: 04/14/2008] [Indexed: 12/21/2022]
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Dale AM, Strickland J, Symanzik J, Franzblau A, Evanoff B. Reliability of hand diagrams for the epidemiologic case definition of carpal tunnel syndrome. JOURNAL OF OCCUPATIONAL REHABILITATION 2008; 18:233-248. [PMID: 18521726 PMCID: PMC9012995 DOI: 10.1007/s10926-008-9139-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 05/13/2008] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to evaluate the inter-rater reliability of hand diagrams, which are commonly used in research case definitions of carpal tunnel syndrome (CTS). To evaluate the potential of non-random misclassification of cases, we also studied predictors of rater disagreement as a function of personal and work factors, and of hand symptoms not classic for CTS. Participants in a longitudinal study investigating the development of CTS completed repeated self-administered questionnaires. Three experienced clinicians, blind to subjects' work or personal history, independently rated all hand diagrams on an ordinal scale from 0 to 3. Disagreements between ratings were resolved by consensus. Reliability was measured by the weighted kappa statistic. Logistic regression models evaluated predictors of disagreement. Three hundred and thirty-three subjects completed 494 hand diagrams. Eighty-five percent were completed by self-administered questionnaire and 15% by telephone interview. Weighted kappa values representing agreement among the three raters, were 0.83 (95% CI: 0.78, 0.87) for right hand diagrams and 0.88 (95% CI: 0.83, 0.91) for left hand diagrams. Ratings from hand diagrams obtained by telephone interview produced better agreement. Agreement among raters was not affected by subjects' personal or work factors. Disagreement among raters was associated with the presence of hand/wrist symptoms other than classic CTS symptoms. Overall, high levels of agreement were attained by independent raters of hand diagrams. Personal factors did not affect agreement among raters, but presence of non-CTS symptoms seemed to affect results and should be considered in studies focused on diverse populations with heterogeneity of upper extremity symptoms.
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Affiliation(s)
- Ann Marie Dale
- Department of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Avenue, Saint Louis, MO 63110, USA.
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Palmer KT. Diagnosing soft tissue rheumatic disorders of the upper limb in epidemiological studies of vibration-exposed populations. Int Arch Occup Environ Health 2007; 81:575-93. [PMID: 17909839 PMCID: PMC3636680 DOI: 10.1007/s00420-007-0254-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 09/05/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate approaches adopted to diagnose soft tissue rheumatic disorders of the upper limb (ULDs) in vibration-exposed populations and in other settings, and to compare their methodological qualities. METHODS Systematic searches were made of the Medline, Embase, and CINAHL electronic bibliographic databases, and of various supplementary sources (textbooks, reviews, conference and workshop proceedings, personal files). For vibration-exposed populations, qualifying papers were scored in terms of the provenance of their measuring instruments (adequacy of documentation, standardisation, reliability, criterion-related and content validity). Similar criteria were applied to general proposals for whole diagnostic schemes, and evidence was collated on the test-retest reliability of symptom histories and clinical signs. RESULTS In total, 23 relevant reports were identified concerning vibration-exposed populations--21 involving symptoms and 9 involving examination/diagnosis. Most of the instruments employed scored poorly in terms of methodological quality. The search also identified, from the wider literature, more than a dozen schemes directed at classifying ULDs, and 18 studies of test-retest reliability of symptoms and physical signs in the upper limb. Findings support the use of the standardised Nordic questionnaire for symptom inquiry and suggest that a range of physical signs can be elicited with reasonable between-observer agreement. Four classification schemes rated well in terms of content validity. One of these had excellent documentation, and one had been tested for repeatability, agreement with an external reference standard, and utility in distinguishing groups that differed in disability, prognosis and associated risk factors. CONCLUSIONS Hitherto, most studies of ULDs in vibration-exposed populations have used custom-specified diagnostic methods, poorly documented, and non-stringent in terms of standardisation and supporting evidence of reliability and/or validity. The broader literature contains several question sets and procedures that improve upon this, and offer scope in vibration-exposed populations to diagnose ULDs more systematically.
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Affiliation(s)
- Keith T Palmer
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
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Larsson B, Søgaard K, Rosendal L. Work related neck-shoulder pain: a review on magnitude, risk factors, biochemical characteristics, clinical picture and preventive interventions. Best Pract Res Clin Rheumatol 2007; 21:447-63. [PMID: 17602993 DOI: 10.1016/j.berh.2007.02.015] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this review is to scrutinize the physiology of neck-shoulder pain and trapezius myalgia based on the most recent scientific literature. Therefore, systematic literature searches have been conducted. Occurrence of neck-shoulder pain, risk factors for development of neck-shoulder pain, and its work-relatedness are addressed. Furthermore, the latest information on the biochemical milieu within healthy and painful neck-shoulder muscles is reviewed. Finally diagnosis of and intervention for neck and shoulder pain are discussed.
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Affiliation(s)
- Britt Larsson
- Division of Rehabilitation Medicine, Department of Neuroscience and Locomotion, Faculty of Health Sciences, and Pain and rehabilitation centre, University Hospital, 581 85 Linköping, Sweden
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Karels CH, Bierma-Zeinstra SMA, Burdorf A, Verhagen AP, Nauta AP, Koes BW. Social and psychological factors influenced the course of arm, neck and shoulder complaints. J Clin Epidemiol 2007; 60:839-48. [PMID: 17606181 DOI: 10.1016/j.jclinepi.2006.11.012] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 11/14/2006] [Accepted: 11/17/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the clinical course and prognostic factors of complaints of arm, neck, and shoulder. STUDY DESIGN AND SETTING A prospective cohort study in physical therapy practice. Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and/or upper extremities. Participants filled in questionnaires at baseline, 3 months, and 6 months. The main outcome measure was the persistence of complaints over 6-month follow-up. Possible predictors like social and psychological factors, physical factors, and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements. RESULTS Of the 624 participants at baseline 543 (87%) returned at least one follow-up questionnaire. At 6-month follow-up, 40% had persisting pain and discomfort. Somatization, kinesiophobia, catastrophizing, and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population. In those with paid work (77%), catastrophizing, low decision authority at work, and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months. CONCLUSION 40% of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course.
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Affiliation(s)
- C H Karels
- Department of General Practice, Erasmus MC, The Netherlands.
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Kryger AI, Lassen CF, Andersen JH. The role of physical examinations in studies of musculoskeletal disorders of the elbow. Occup Environ Med 2007; 64:776-81. [PMID: 17522132 PMCID: PMC2078422 DOI: 10.1136/oem.2005.026260] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To present data on pain and physical findings from the elbow region, and to discuss the role of diagnostic criteria in epidemiological studies of epicondylitis. METHODS From a cohort of computer workers a subgroup of 1369 participants, who reported at least moderate pain in the neck and upper extremities, were invited to a standardised physical examination. Two independent physical examinations were performed-one blinded and one not blinded to the medical history. Information concerning musculoskeletal symptoms was obtained by a baseline questionnaire and a similar questionnaire completed on the day of examination. RESULTS 349 participants met the authors' criteria for being an arm case and 249 were elbow cases. Among the 1369 participants the prevalence of at least mild palpation tenderness and indirect tenderness at the lateral epicondyle was 5.8%. The occurrence of physical findings increased markedly by level of pain score. Only about one half with physical findings fulfilled the authors' pain criteria for having lateral epicondylitis. A large part with physical findings reported no pain at all in the elbow in any of the two questionnaires, 28% and 22%, respectively. Inter-examiner reliability between blinded and not blinded examination was found to be low (kappa value (0.34-0.40)). CONCLUSION Very few with at least moderate pain in the elbow region met common specific criteria for lateral epicondylitis. The occurrence of physical findings increased markedly by level of pain score and the associations were strongest with pain intensity scores given just before the examination. Physical signs were commonly found in subjects with no pain complaints. No further impact was achieved if the physical examination was not blinded to the medical history. Furthermore, the authors propose that pain, clinical signs and disability are studied as separate outcomes, and that the diagnoses of lateral epicondylitis should be used only for cases with classical signs of inflammation reflected by severe pain, which for example conveys some disability.
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Affiliation(s)
- Ann Isabel Kryger
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg, Denmark.
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Huisstede BMA, Miedema HS, Verhagen AP, Koes BW, Verhaar JAN. Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder. Occup Environ Med 2006; 64:313-9. [PMID: 17043078 PMCID: PMC2092547 DOI: 10.1136/oem.2005.023861] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no universally accepted way of labelling or defining upper-extremity musculoskeletal disorders. A variety of names are used and many different classification systems have been introduced. OBJECTIVE To agree on an "unambiguous language" concerning the terminology and classification that can be used by all relevant medical and paramedical disciplines in the Netherlands. METHODS A Delphi consensus strategy was initiated. The outcomes of a multidisciplinary conference were used as a starting point. In total, 47 experts in the field of upper-extremity musculoskeletal disorders were delegated by 11 medical and paramedical professional associations to form the expert panel for the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis and a feedback report. RESULTS After three Delphi rounds, consensus was achieved. The experts reported the consensus in a model. This so-called CANS model describes the term, definition and classification of complaints of arm, neck and/or shoulder (CANS) and helps professionals to classify patients unambiguously. CANS is defined as "musculoskeletal complaints of arm, neck and/or shoulder not caused by acute trauma or by any systemic disease". The experts classified 23 disorders as specific CANS, because they were judged as diagnosable disorders. All other complaints were called non-specific CANS. In addition, the experts defined "alert symptoms" on the top of the model. CONCLUSIONS The use of the CANS model can increase accurate and meaningful communication among healthcare workers, and may also have a positive influence on the quality of scientific research, by enabling comparison of data of different studies.
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Affiliation(s)
- B M A Huisstede
- Department of General Practice, Netherlands Expert Center for Work-related Musculoskeletal Disorders, Erasmus MC, Rotterdam, The Netherlands.
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Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, Imbernon E, Goldberg M. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. ACTA ACUST UNITED AC 2006; 55:765-78. [PMID: 17013824 DOI: 10.1002/art.22222] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Since 2002, an epidemiologic surveillance system of work-related, upper-limb musculoskeletal disorders (MSDs) has been implemented in France's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population. METHODS The surveillance was based on a network of occupational physicians (OPs) and used the recommendations of a group of European experts (criteria document consensus). In 2002-2003, 80 of 400 OPs volunteered to participate. All underwent a training program to standardize the physical examination. Health status was assessed by self-administered questionnaire and physical examination. Occupational risk factors were assessed by self-administered questionnaire. Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document. RESULTS More than 50% of the 2,685 men and women randomly included in 2002-2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and approximately 30% experienced them in the preceeding week. The prevalence of clinically diagnosed MSDs was high: approximately 13% of workers experienced at least 1 of the MSDs. The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis. The prevalence of MSDs increased with age and varied widely across economic sectors and occupations. More than half of the workers were exposed to at least 2 risk factors of MSDs. Exposure varied according to industrial activity and occupation. According to the criteria document, a high percentage of MSD cases could be classified as probably work related (95% in men and 89% in women age <50, and 87% in men and 69% in women age >50). CONCLUSION Nonspecific upper-limb symptoms and specific upper-limb MSDs are common in the working population. These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs.
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Affiliation(s)
- Yves Roquelaure
- Laboratory of Ergonomics and Occupational Health, CHU, Angers, France.
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Walker-Bone K, Cooper C. Hard work never hurt anyone: or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb. Ann Rheum Dis 2005; 64:1391-6. [PMID: 16162900 PMCID: PMC1755253 DOI: 10.1136/ard.2003.020016] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pain in the neck and upper limb is common and contributes considerably to absence from work due to sickness. Evidence suggest that prolonged abnormal posture and repetition contribute to such conditions. Psychosocial risk factors may also play a part in the aetiology of upper limb disorders.
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Affiliation(s)
- K Walker-Bone
- Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, East Sussex BN1 9PH, UK.
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Walker-Bone K, Cooper C. Hard work never hurt anyone--or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb. Ann Rheum Dis 2005; 64:1112-7. [PMID: 15829576 PMCID: PMC1755625 DOI: 10.1136/ard.2004.026484] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pain in the neck and upper limb is common and contributes greatly to absence due to sickness. Evidence is accumulating that factors such as prolonged abnormal posture and repetition contribute to these conditions. Psychosocial factors may also play a part and the relative importance of these is not yet known. Primary and secondary prevention trials are needed.
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Affiliation(s)
- K Walker-Bone
- Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, East Sussex BN1 9PH, UK.
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Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. ACTA ACUST UNITED AC 2004; 51:642-51. [PMID: 15334439 DOI: 10.1002/art.20535] [Citation(s) in RCA: 358] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the prevalence, interrelation, and impact of musculoskeletal disorders of the upper limb in the general population. METHODS A total of 9,696 randomly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening questionnaire and a standardized physical examination in symptomatic subjects. Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs. The overlap and impact on daily activities and healthcare utilization were explored. RESULTS Among 6,038 first-stage responders, 3,152 reported upper limb symptoms and 1,960 were subsequently examined. Of subjects with pain, 44.8% had 1 or more specific soft-tissue disorders. Site-specific prevalence rates were as follows: shoulder tendinitis 4.5% among men and 6.1% among women; adhesive capsulitis 8.2% among men and 10.1% among women; lateral epicondylitis 1.3% among men and 1.1% among women; de Quervain's disease 0.5% among men and 1.3% among women; other tenosynovitis of the hand or wrist, 1.1% among men and 2.2% among women. Specific disorders tended to cluster (P < 0.001) in individuals, with particular overlap at the shoulder. Compared with subjects with nonspecific pain, those with specific disorders more often reported inability to perform everyday tasks (P < 0.05), consultation with a doctor (P < 0.05), and use of prescribed medication (P < 0.05). CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders. These disorders have a substantial impact on physical function and use of health care.
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Walker-Bone KE, Palmer KT, Reading I, Cooper C. Soft-tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors. Semin Arthritis Rheum 2004; 33:185-203. [PMID: 14671728 DOI: 10.1016/s0049-0172(03)00128-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To review the epidemiologic literature concerning the occurrence of and the risk factors for pain and specific soft-tissue rheumatic conditions that affect the neck and upper limbs. METHODS An extensive search of the literature, including a search of Medline and EMBASE, authoritative recent reviews, and relevant textbooks, was performed. Studies that furnished data about the occurrence of or risk factors for regional pain or specific soft-tissue entities were extracted. RESULTS Numerous epidemiologic studies among different populations suggest a high prevalence of pain in the neck (10% to 19%), shoulder (18% to 26%), elbow (8% to 12%), and wrist/hand (9% to 17%) at any point in time. Less clear is the proportion of pain caused by specific upper-limb disorders as compared with nonspecific pain; however, as many as 6% of adults may have carpal tunnel syndrome. Significant risk factors for these disorders include age, female gender, obesity, and association with mechanical exposures (eg, posture, force, repetition, vibration) in the workplace. Also implicated are psychologic well-being and psychosocial workplace factors such as high levels of demand, poor control, and poor support. CONCLUSION Pain and soft-tissue rheumatic disorders of the neck and upper limb are common. It appears that individual, mechanical, and psychosocial factors all contribute to upper-limb disorders, suggesting that future strategies for prevention will need to address each of these factors if they are to be successful.
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Affiliation(s)
- Karen E Walker-Bone
- Medical Research Council Environmental Epidemiology Unit, University of Southampton, England
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