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Zhang T, Wang Y, Ding L, Ma C. Efficacy of hypertonic dextrose proliferation therapy in the treatment of rotator cuff lesions: a meta-analysis. J Orthop Surg Res 2024; 19:297. [PMID: 38750541 PMCID: PMC11094990 DOI: 10.1186/s13018-024-04754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND One of the most prevalent illnesses of the shoulder is rotator cuff tendinosis, which is also a major contributor to shoulder discomfort and shoulder joint dysfunction. According to statistics, rotator cuff tendinosis occurs in 0.3-5.5% of cases and affects 0.5-7.4% of people annually. It will be necessary to conduct a meta-analysis to evaluate the efficacy of hypertonic glucose proliferation therapy in the treatment of rotator cuff problems. METHODS The databases Cochrane PubMed, Library, Web of Science and EMbase, are retrieved by the computer. Individuals with rotator cuff lesions in the intervention group were treated with hypertonic dextrose proliferation therapy, whereas individuals in the control condition were treated with a placebo. Outcome markers for rotator cuff lesions patients; Pursuant to studies, the visual analogue scale (VAS) score, the shoulder pain & disability index (SPADI), & other metrics are used to evaluate the effects of hypertonic dextrose proliferation treatment on individuals with rotator cuff diseases. After carefully evaluating the calibre of the literature, data analysis was performed utilising the RevMan 5.3 programme. RESULTS Meta-analysis finally contained 6 papers. In six investigations, the test & control group's VAS scores improved, with the test team's score considerably outperforming the control team [standardized mean difference (SMD): 1.10; 95% Cl: 0.37,1.83; P < 0.01], shoulder pain and disability index (SPADI) score (SMD:8.13; 95% Cl: 5.34,10.91; P < 0.01), Flexion (SMD:5.73; 95% Cl: 0.99,10.47; P < 0.05), Abduction (SMD:6.49; 95% Cl: 0.66,12.31; P < 0.05), Internal rotation (SMD:-1.74; 95% Cl: -4.25,0.78; P = 0.176) and External rotation (SMD:2.78; 95% Cl: -0.13,5.69; P = 0.062). CONCLUSION The findings of this study suggest that individuals with rotator cuff injuries may benefit from hypertonic dextrose proliferation treatment based on the visual analogue scale (VAS) score, the Shoulder Pain and Disability Index (SPADI) score, Flexion, & Abduction. These results must, nevertheless, be supported by high-caliber follow-up research.
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Affiliation(s)
- Ting Zhang
- Department of Rehabilitation Medicine, Central Hospital of Wuhan, Hubei Province, China
| | - YanFu Wang
- Department of Rehabilitation Medicine, Central Hospital of Wuhan, Hubei Province, China
| | - Lin Ding
- Department of Rehabilitation Medicine, Central Hospital of Wuhan, Hubei Province, China.
| | - ChaoYang Ma
- Department of Rehabilitation Medicine, Central Hospital of Wuhan, Hubei Province, China.
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Keightley JGA, Haagman B, Magner JD, Debenham JR. Models of care for musculoskeletal shoulder pain in spinal cord injury: A scoping review. J Spinal Cord Med 2024; 47:327-344. [PMID: 36913538 PMCID: PMC11044743 DOI: 10.1080/10790268.2023.2183335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
CONTEXT Spinal cord injury (SCI) is a neurological condition that significantly impacts a person's lifestyle, health and well-being. Many individuals with SCI experience secondary musculoskeletal shoulder pain. This scoping review examines the current research on the diagnosis and management of shoulder pain in SCI. OBJECTIVE The aim of this Scoping Review was (1) to chart peer-reviewed literature regarding the diagnosis and management of shoulder pain as it relates to SCI and (2) identify gaps in this body of literature to inform future research priorities. METHODS Six electronic databases were searched from inception until April 2022. In addition, reviewers scanned the reference lists of identified articles. Articles from peer-reviewed sources that reported diagnostic or management procedures for musculoskeletal shoulder conditions within the SCI population were considered and 1679 articles were identified. Title and abstract screening, full text review, and data extraction were undertaken by two independent reviewers. RESULTS Eighty seven articles were included, covering diagnosis or management of shoulder pain in SCI. CONCLUSION Whilst the most commonly reported diagnostic procedures and management strategies reflect contemporary practice for shoulder pain, the entire body of literature demonstrates inconsistencies in methodologies. In places, the literature continues to perceive value in procedures inconsistent with best practice. These findings encourage researchers to pursue the development of robust models of care for musculoskeletal shoulder pain in SCI using a collaborative and integrated approach, combining best practice for musculoskeletal shoulder pain alongside clinical expertise in the management of SCI.
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Affiliation(s)
- Jordan G. A. Keightley
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - Bianca Haagman
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - Julie D. Magner
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - James R. Debenham
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
- Majarlin Kimberley Centre for Remote Health, The University of Notre Dame Australia, Broome, Western Australia, Australia
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3
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Brandariz R, Charbonnier C, Culebras Almeida A, Lädermann A, Cunningham G. The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis. BMC Musculoskelet Disord 2023; 24:888. [PMID: 37968608 PMCID: PMC10647087 DOI: 10.1186/s12891-023-06957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Caecilia Charbonnier
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alejandro Culebras Almeida
- Shoulder and Elbow Center La Colline, Geneva, Switzerland
- Department of Orthopaedics and Traumatology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Alexandre Lädermann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Gregory Cunningham
- Shoulder and Elbow Center La Colline, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
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Minder U, Arnet U, Müller E, Boninger M, Bossuyt FM. Changes in neuromuscular activation, heart rate and rate of perceived exertion over the course of a wheelchair propulsion fatigue protocol. Front Physiol 2023; 14:1220969. [PMID: 37920802 PMCID: PMC10619735 DOI: 10.3389/fphys.2023.1220969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
Shoulder pain is common in persons with spinal cord injury and has been associated with wheelchair use. Fatigue related compensation strategies have been identified as possibly impacting the development of shoulder injury and pain. The purpose of this study was to investigate the progression of performance fatigability (i.e., decline in objective measure of performance including neuromuscular activation and increase in heart rate) and perceived fatigability (i.e., increased perceived exertion) during a 15-min fatigue protocol including maximum voluntary overground wheelchair propulsion. Fifty participants with paraplegic spinal cord injury completed three 4-min rounds of wheelchair propulsion, separated by 90 s of rest, on a figure-8 course consisting of two turns and full stops per lap in their manual wheelchairs (ClinicalTrials.gov: NCT03153033). Electromyography (EMG) signal of five muscles acting on the shoulder joint, heart rate (HR), and rate of perceived exertion (RPE) were measured at the beginning and end of every 4 min of propulsion. Root Mean Square (RMS) and Mean Power Frequency were calculated from EMG data. There was a significant increase in %RMS of the pectoralis major pars sternalis and trapezius pars descendens, HR, and RPE with greatest changes during the first 4 min of the protocol. The observed changes in neuromuscular activation in only two of the shoulder muscles may impact muscular imbalances and the development of shoulder injuries and should be further studied. The current study gives clearer insight into the mechanisms of performance fatigability and perceived fatigability throughout a wheelchair propulsion fatigue protocol.
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Affiliation(s)
- Ursina Minder
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Ursina Arnet
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Erich Müller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fransiska M. Bossuyt
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Switzerland
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Cooper K, Alexander L, Brandie D, Brown VT, Greig L, Harrison I, MacLean C, Mitchell L, Morrissey D, Moss RA, Parkinson E, Pavlova AV, Shim J, Swinton PA. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technol Assess 2023; 27:1-389. [PMID: 37929629 PMCID: PMC10641714 DOI: 10.3310/tfws2748] [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] [Indexed: 11/07/2023] Open
Abstract
Background Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review questions (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases (n = 9), trial registries (n = 6), grey literature databases (n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021. Results Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect sizeResistance:Flexibility = 0.18 [95% CrI 0.07 to 0.29]) and proprioception (effect sizeResistance:Proprioception = 0.16 [95% CrI -1.8 to 0.32]); (2) when performing strengthening exercise it may be most beneficial to combine concentric and eccentric modes (effect sizeEccentricOnly:Concentric+Eccentric = 0.48 [95% CrI -0.13 to 1.1]; and (3) exercise may be most beneficial when combined with another conservative modality (e.g. injection or electro-therapy increasing effect size by ≈0.1 to 0.3). Mixed-method review - 94 studies (11 qualitative) provided evidence that exercise interventions for tendinopathy can largely be considered feasible and acceptable, and that several important factors should be considered when prescribing exercise for tendinopathy, including an awareness of potential barriers to and facilitators of engaging with exercise, patients' and providers' prior experience and beliefs, and the importance of patient education, self-management and the patient-healthcare professional relationship. Limitations Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made. Conclusion The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence. Future work There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes. Study registration This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review). Funding This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kay Cooper
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - David Brandie
- Sportscotland Institute of Sport, Airthrey Road, Stirling, UK
| | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Isabelle Harrison
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Colin MacLean
- Library Services, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Laura Mitchell
- NHS Grampian, Physiotherapy Department, Ellon Health Centre, Schoolhill, Ellon, Aberdeenshire, UK
| | - Dylan Morrissey
- William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, UK
| | - Rachel Ann Moss
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Eva Parkinson
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | | | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
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6
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Rossi LA, Piuzzi N, Tanoira I, Brandariz R, Huespe I, Ranalletta M. Subacromial Platelet-Rich Plasma Injections Produce Significantly Worse Improvement in Functional Outcomes in Patients With Partial Supraspinatus Tears Than in Patients With Isolated Tendinopathy. Arthroscopy 2023; 39:2000-2008. [PMID: 37001744 DOI: 10.1016/j.arthro.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To compare the effect of subacromial leukocyte-rich platelet-rich plasma (PRP) injections in patients with isolated rotator cuff tendinopathy (RCT) and those with partial-thickness rotator cuff tears (PTRCTs) based on functional outcomes, pain improvement, sleep disturbances, and return to sports. METHODS Between November 2019 and March 2021, 150 patients underwent PRP injections at our institution for refractory rotator cuff tendinopathy and partial rotator cuff tears (105 RCTs and 45 PTRCTs). The American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE) and The Pittsburgh Sleep Quality Index were evaluated at 2-, 6-, and 12-month follow-up. Return to sports was also evaluated. An ultrasound examination was performed to evaluate structural outcomes 12 months after the injection. RESULTS The mean age was 36.6 years (±9.08). Overall, the ASES, VAS, SANE, and Pittsburgh scores showed statistical improvement after the injection (P < .01). Specifically, the improvement in the ASES score, which was the primary outcome measure was significantly greater in the group without tears than in the group with PTRCTs at all follow-up times. Moreover, 94% of the patients in the isolated RCT group and 49% in the PTRCTs group achieved a substantial clinical benefit at 12 months follow-up. Ten out of the 50 patients (20%) who received PRP injections due to a partial RC tear underwent surgery due to the lack of clinical improvement. CONCLUSIONS Subacromial PRP injections produced a significant improvement in shoulder function, pain, and sleep disturbances in most patients with RCT refractory to conservative treatment that was maintained at the 12-month follow-up. Moreover, most patients returned to sports at the same level prior to injury. However, improvement in symptoms and functional outcomes was significantly worse in patients who had a PTRCT compared with patients who had an isolated tendinopathy. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Nicolás Piuzzi
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Brandariz
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan Huespe
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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7
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Wang Z, Liao Y, Wang C, Tang C, Fang C, Luo J, Liu H, Mo X, Wang Z, Shen L, Wang J, Chen X, Yin Z, Li J, Shen W. Stem cell-based therapeutic strategies for rotator cuff tendinopathy. J Orthop Translat 2023; 42:73-81. [PMID: 37664079 PMCID: PMC10470406 DOI: 10.1016/j.jot.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
Rotator cuff tendinopathy is a common musculoskeletal disorder that imposes significant health and economic burden. Stem cell therapy has brought hope for tendon healing in patients with final stage rotator cuff tendinopathy. Some clinical trials have confirmed the effectiveness of stem cell therapy for rotator cuff tendinopathy, but its application has not been promoted and approved. There are still many issues that should be solved prior to using stem cell therapy in clinical applications. The optimal source and dose of stem cells for rotator cuff tendinopathy should be determined. We also proposed novel prospective approaches that can overcome cell population heterogeneity and standardize patient types for stem cell applications. The translational potential of this article This review explores the optimal sources of stem cells for rotator cuff tendinopathy and the principles for selecting stem cell dosages. Key strategies are provided for stem cell population standardization and recipient selection.
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Affiliation(s)
- Zetao Wang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Youguo Liao
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Canlong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenqi Tang
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Binjiang Institute of Zhejiang University, Hangzhou, China
| | - Cailian Fang
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Junchao Luo
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Hengzhi Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianan Mo
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Zicheng Wang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Lingfang Shen
- Air Force Health Care Center for Special Services, Hangzhou, China
| | | | - Xiao Chen
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Zi Yin
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianyou Li
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Weiliang Shen
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Orthopedic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
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8
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Gumina S, Kim H, Jung Y, Song HS. Rotator cuff degeneration and healing after rotator cuff repair. Clin Shoulder Elb 2023; 26:323-329. [PMID: 37607856 PMCID: PMC10497920 DOI: 10.5397/cise.2023.00430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
Rotator cuff tear is a common shoulder injury that compromises both function and quality of life. Despite the prevalence of the injury and advancements in repair techniques, a significant percentage of these repairs fail. This review aims to explore the multifactorial reasons behind this failure, including the degenerative nature of the rotator cuff tendon, inherent and extrinsic factors, and the role of hypoxia in tissue degeneration. Additionally, it elucidates potential strategies for improving healing outcomes.
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Affiliation(s)
- Stefano Gumina
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Younsung Jung
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Song Y, Li P, Xu Y, Lin Z, Deng Z, Chen C. Menstrual Blood-Derived Mesenchymal Stem Cells Encapsulated in Autologous Platelet-Rich Gel Facilitate Rotator Cuff Healing in a Rabbit Model of Chronic Tears. Am J Sports Med 2023:3635465231168104. [PMID: 37184028 DOI: 10.1177/03635465231168104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Successful management of chronic rotator cuff (RC) tears remains a challenge owing to its limited intrinsic healing capacity and unsatisfactory failure rate. Menstrual blood-derived mesenchymal stem cells (MenSCs) have the potential to differentiate into the chondrogenic or osteogenic lineage. Autologous platelet-rich gel (APG), a gel material derived from platelet-rich plasma (PRP), can be applied as a carrier system for cell delivery and also as a releasing system for endogenous growth factors. PURPOSE To investigate the effect of human MenSCs encapsulated in APG (MenSCs@APG) on the healing of chronic RC tears in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS After evaluation of the effect of PRP on MenSC proliferation or differentiation, the stem cells were encapsulated in APG for in vivo injection. Supraspinatus tenotomy from the right greater tuberosity was performed on 45 New Zealand White rabbits. After 6 weeks, these rabbits were randomly allocated to 3 supplemental treatments during supraspinatus repair: saline injection (control [CTL] group), APG injection (APG group), and MenSCs@APG injection (MenSCs@APG group). At week 18, these rabbits were sacrificed to harvest the humerus-supraspinatus tendon complexes for micro-computed tomography (CT), histological evaluation, tensile test, and MenSC tracking. RESULTS In vitro results showed that APG can stimulate MenSC proliferation and enhance chondrogenic or osteogenic differentiation. In vivo results showed that APG can act as a carrier for delivering MenSCs into the healing site, and also as a stimulator for enhancing the in vivo performance of MenSCs. Micro-CT showed that bone volume/total volume and trabecular thickness of the new bone in the MenSCs@APG group presented significantly larger values than those of the APG or CTL group (P < .05 for all). Histologically, compared with the CTL or APG group, significantly more mature fibrocartilage regenerated at the healing site in the MenSCs@APG group. A large number of human nuclei-stained cells were observed in the MenSCs@APG group, presenting a similar appearance to fibrochondrocytes or osteocytes. Biomechanically, the MenSCs@APG group showed significantly higher failure load and stiffness than the APG or CTL group (P < .05 for all). CONCLUSION Human MenSCs@APG facilitated RC healing in a rabbit model of chronic tears. CLINICAL RELEVANCE Autogenous MenSCs@APG may be a new stem cell-based therapy for augmenting RC healing in the clinic.
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Affiliation(s)
- Ya Song
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ping Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhangyuan Lin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenhan Deng
- Department of Sports Medicine, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, China
| | - Can Chen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Sports Medicine, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, China
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Gatot C, Lie HM, Tijauw Tjoen DL. Human Dermal Allograft Patch Augmentation of Degenerate Rotator Cuff Tendon Using a Single Lateral-Row Technique. Arthrosc Tech 2022; 11:e2143-e2151. [PMID: 36632385 PMCID: PMC9826975 DOI: 10.1016/j.eats.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
The role of biological augmentation in arthroscopic rotator cuff repair surgery has increased over the years. It has shown favorable healing rates and functional outcomes. Patch augmentation is commonly applied in repairs of massively retracted cuff tears, full-thickness tears, revision repair, or open cuff surgery. There is a paucity of literature on the use of patch augmentation when dealing with a chronic degenerate tendon associated with small-sized cuff tears. In recent years, the resorbable bioinductive bovine collagen implant has gained popularity for its application in partial-thickness tears via an isolated bioinductive repair fashion, without traditional rotator cuff repair. These bioinductive implants, albeit promising in their biological properties for tendon repair, lack structural strength and do not confer similar biomechanical advantages as human dermal allograft. We share our surgical technique for an arthroscopic patch augmentation involving human dermal allograft, using a single-lateral row surgical fixation, to address a degenerate cuff tendon with small-sized rotator cuff tear. We believe that our use of a human dermal patch augmentation conferred increased biomechanical advantage and reduced costs while delivering favorable outcomes for patients in our value-driven care.
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Affiliation(s)
- Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore,Address correspondence to Cheryl Gatot, Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd., Academia, Level 4, Singapore 169856.
| | - Hannah Marian Lie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Shoulder Rotational Strength and Range of Motion in Unilateral and Bilateral Overhead Elite Athletes. J Sport Rehabil 2022; 31:963-970. [PMID: 35487574 DOI: 10.1123/jsr.2021-0342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022]
Abstract
CONTEXT Overhead athletes place tremendous demands on the shoulder complex, which result in adaptive kinematics but potential susceptibility to injury. This study aimed to compare shoulder glenohumeral range of motion (ROM) and rotator muscles strength in bilateral and unilateral overhead sports. DESIGN Cross-sectional study; secondary care. METHODS Forty-two elite athletes (17.7 [4.5] y; 42.9% female), including 18 swimmers and 24 badminton players, were included. Preseason glenohumeral rotation ROM and isokinetic shoulder internal and external rotator muscles strength was tested (60°·s-1). Bilateral (nondominant:dominant) and agonist:antagonist (external rotator:internal rotator) conventional and functional deceleration ratios (eccentric to concentric) were calculated. The impact of sport and number of competitive years on shoulder ROM and strength was tested. RESULTS Badminton players had greater glenohumeral internal rotation deficit, total ROM deficit, and lower bilateral strength ratio than swimmers (P < .050). Rotational strength was positively associated with the competitive years, but greater in swimmers (P < .050) and on the internal rotator (P < .001). The functional deceleration ratio was negatively associated with the competitive years on the dominant side in swimmers and for both sides in badminton. CONCLUSIONS Unilateral overhead athletes had greater ROM and rotational strength asymmetries than bilateral athletes. Interestingly, the functional deceleration ratio was lower over time on the dominant shoulder for both sports, but, surprisingly, also on the nondominant shoulder in badminton, potentially creating a greater risk for shoulder injuries.
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Rentz C, Legerlotz K. Handball-specific loading acutely reduces the acromiohumeral distance in experienced handball players and in non-handball experienced athletes. Front Sports Act Living 2022; 4:997401. [PMID: 36187715 PMCID: PMC9524289 DOI: 10.3389/fspor.2022.997401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Context When playing handball, the preservation of the subacromial space, which can be quantified by the acromiohumeral distance (AHD), plays a crucial role for shoulder health of handball players. Acute effects of handball-specific loading on the subacromial space with consideration of individual adaptions resulting from long-term handball-specific loading experience have yet to be determined in order to prevent injuries such as e. g. an impingement of the supraspinatus tendon. Objective To (1) assess the acute effects of handball-specific loading on the AHD in healthy experienced handball players (HB) and non-handball experienced athletes (CG) and (2) to assess the AHD behavior in relation to individual intrinsic factors to identify possible risk factors and the effect of handball-specific experience associated adaptations. Participants 20 HB (10m; 10f) and 20 CG (10m; 10f); 24 ± 5 years. Intervention Handball-specific loading protocol. Main outcome measures The AHD was measured by ultrasonography at 0° and 60° abduction pre and post intervention. Isometric shoulder strength was measured with hand-held dynamometry. Shoulder range of motion (ROM) was measured with goniometry. Results Handball-specific loading led to significantly reduced AHD in the dominant shoulder in the 60° abducted position in both groups (HB: −1.7 ± 2.0 mm; p = 0.001, d = 0.69; CG: −1.1 ± 2.0 mm; p = 0.024, d = 0.37) and in the non-dominant shoulder in 0° (−0.7 ± 1.5 mm; p = 0.038, d = 0.35) and 60° abducted position (−1.3 ± 1.8 mm; p = 0.004, d = 0.69) in HB only. Handball-specific loading enhanced AHD reduction when elevating the shoulder from 0° to 60° in both groups and arms. Larger shoulder abduction strength affected the maintenance of the AHD positively. HB demonstrated less shoulder strength compared to CG, while ROM did not differ. Conclusions Handball-specific loading can affect the ability to preserve the subacromial space which might put handball players at risk for shoulder injuries. Poor shoulder strength can aggravate this mechanism. Therefore, implementation of strengthening exercises of the external rotator and abductor muscles in the training schedule may improve shoulder health of handball players.
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Pellegrino R, Di Iorio A, Brindisino F, Paolucci T, Moretti A, Iolascon G. Effectiveness of combined extracorporeal shock-wave therapy and hyaluronic acid injections for patients with shoulder pain due to rotator cuff tendinopathy: a person-centered approach with a focus on gender differences to treatment response. BMC Musculoskelet Disord 2022; 23:863. [PMID: 36109717 PMCID: PMC9479346 DOI: 10.1186/s12891-022-05819-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Rotator cuff (RC) tendinopathy is a common shoulder pain condition. Extracorporeal shockwave therapy (ESWT) and hyaluronic acid peritendinous injection are viable treatment options for RC tendinopathy. The aim of this study is to evaluate the response in two different therapeutic rehabilitative approaches, the combined treatment ESWT plus hyaluronic acid injections (E + Hy) compared to ESWT alone (ESWT-al), in a cohort of patients with RC tendinopathy according to gender differences. Methods This is a retrospective longitudinal cohort study of patients with painful RC tendinopathy. Patients that had received a clinical evaluation, a shoulder ultra sound examination, as well as the Shoulder Pain and Disability Index (SPADI) questionnaire, and the Numerical Rating Scale (NRS) for pain at baseline, 1-month (T1) and 2-month follow-ups (T2) were included. Results Medical records of 53 patients were analyzed. In the comparison between baseline to T1 and similarly from baseline to T2, a statistically significant reduction has been reported in the NRS (p < 0.001) and in the SPADI (p < 0.001) in the entire study group. At T1, patients in the E + Hy compared to ESWT-al group, showed a slight but statistically significant reductions in both NRS and SPADI score, while these changes were more evident at T2 (p < 0.001). Interestingly, a gender dimorphism in NRS and in SPADI was found, with female patients that apparently responded better to the combined E + Hy compared to ESWT-al approach. Conclusion This retrospective cohort study suggests that the combination of ESWT plus HyA injections seems to be more effective than ESWT alone in RC tendinopathy in both genders. Moreover, in ESWT alone treatment, male patients reported better outcomes compared to females. However, further randomized controlled trials should be structured to confirm and enforce these conclusions. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05819-3.
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Marcoux JT, Tong L. Fibrocartilaginous Tissue: Why Does It Fail to Heal? Clin Podiatr Med Surg 2022; 39:437-450. [PMID: 35717061 DOI: 10.1016/j.cpm.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tendons and ligaments are critical components in the function of the musculoskeletal system, as they provide stability and guide motion for the biomechanical transmission of forces into bone. Several common injuries in the foot and ankle require the repair of ruptured or attenuated tendon or ligament to its osseous insertion. Understanding the structure and function of injured ligaments and tendons is complicated by the variability and unpredictable nature of their healing. The healing process at the tendon/ligament to bone interface is challenging and often frustrating to foot and ankle surgeons, as they have a high failure rate necessitating the need for revision.
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Affiliation(s)
- John T Marcoux
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Span 3, Boston, MA 02215, USA.
| | - Lowell Tong
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Span 3, Boston, MA 02215, USA
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Jahanian O, Van Straaten MG, Goodwin BM, Lennon RJ, Barlow JD, Murthy NS, Morrow MM. Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury. J Spinal Cord Med 2022; 45:564-574. [PMID: 33166207 PMCID: PMC9246118 DOI: 10.1080/10790268.2020.1834774] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Outpatient clinic at a tertiary medical center.Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI.Outcome Measures: Participants' demographic and anthropometric information, presence of shoulder pain, Wheelchair User's Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy.Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears.Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.
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Affiliation(s)
- Omid Jahanian
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Meegan G. Van Straaten
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Brianna M. Goodwin
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D. Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Melissa M.B. Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA,Correspondence to: Melissa M. B. Morrow, 200 First Street SW, Rochester, MN55905, USA.
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Bhan K, Singh B. Efficacy of Platelet-Rich Plasma Injection in the Management of Rotator Cuff Tendinopathy: A Review of the Current Literature. Cureus 2022; 14:e26103. [PMID: 35875287 PMCID: PMC9297117 DOI: 10.7759/cureus.26103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/24/2022] Open
Abstract
Platelet-rich plasma (PRP) is being projected as a newer and superior treatment option for rotator cuff tendinopathy. With the first use of PRP in trauma and orthopedics dating back only to 1998, its advent into the field is relatively recent. Thus, data on long-term efficacy, large cohort studies, or large randomized controlled trials are fairly limited. Moreover, owing to the absence of standardized methods of platelet extraction and lack of consensus on the ideal concentration of platelets in PRP, data comparison from different studies is difficult. Things are complicated by the fact that it is also not clear whether a single injection of PRP is therapeutic or if multiple serial injections are needed to produce the desired effects. The literature on efficacy and pain relief is also obtained from studies with low sample sizes and short follow-ups. The dropout rate and noncompliance rate were also found to be high in some studies. Thus, the data is often not clinically significant and may also be biased due to the non-standardized inclusion and exclusion criteria of the studies. Though multiple studies have suggested good pain control with PRP injection, many studies have found that PRP injection therapy may not be any better than the physical therapy regimen prescribed to patients with rotator cuff tendinopathy. Also, the data on the efficacy of PRP on shoulder function and shoulder range of motion is at variance. This submission aims to evaluate the efficacy and use of PRP in the management of rotator cuff tendinopathy.
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Wang HN, Rong X, Yang LM, Hua WZ, Ni GX. Advances in Stem Cell Therapies for Rotator Cuff Injuries. Front Bioeng Biotechnol 2022; 10:866195. [PMID: 35694228 PMCID: PMC9174670 DOI: 10.3389/fbioe.2022.866195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Rotator cuff injury is a common upper extremity musculoskeletal disease that may lead to persistent pain and functional impairment. Despite the clinical outcomes of the surgical procedures being satisfactory, the repair of the rotator cuff remains problematic, such as through failure of healing, adhesion formation, and fatty infiltration. Stem cells have high proliferation, strong paracrine action, and multiple differentiation potential, which promote tendon remodeling and fibrocartilage formation and increase biomechanical strength. Additionally, stem cell-derived extracellular vesicles (EVs) can increase collagen synthesis and inhibit inflammation and adhesion formation by carrying regulatory proteins and microRNAs. Therefore, stem cell-based therapy is a promising therapeutic strategy that has great potential for rotator cuff healing. In this review, we summarize the advances of stem cells and stem cell-derived EVs in rotator cuff repair and highlight the underlying mechanism of stem cells and stem cell-derived EVs and biomaterial delivery systems. Future studies need to explore stem cell therapy in combination with cellular factors, gene therapy, and novel biomaterial delivery systems.
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Affiliation(s)
- Hao-Nan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xiao Rong
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Lu-Ming Yang
- Musculoskeletal Sonography and Occupational Performance Lab, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Wei-Zhong Hua
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Guo-Xin Ni,
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Arnet U, Boninger ML, Cools A, Bossuyt FM. Effect of Fatiguing Wheelchair Propulsion and Weight Relief Lifts on Subacromial Space in Wheelchair Users. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:849629. [PMID: 36189050 PMCID: PMC9397688 DOI: 10.3389/fresc.2022.849629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThis study aimed to identify targets of intervention for reducing shoulder pain in wheelchair users with spinal cord injury (SCI) by (1) examining changes in subacromial space [acromiohumeral distance (AHD) and occupation ratio (OccRatio)] with fatiguing wheelchair propulsion, and different loading conditions [unloaded position vs. weight relief lifts (WRL)]; (2) associating these changes with wheelchair user capacity, as well as (3) identifying subject characteristics associated with subacromial space, such as sex, lesion level, time since injury, body mass index and impaired shoulder range of motion.MethodsFifty manual wheelchair users with SCI [11 females, age = 50.5 (9.7) years, time since injury = 26.2 (11.4) years] participated in this quasi-experimental one-group pretest-posttest study. Ultrasound images were used to define AHD during an unloaded position, and during personal and instructed WRL before and after fatiguing wheelchair propulsion. Furthermore, supraspinatus and biceps thickness defined from ultrasound images were used to calculate OccRatios. Wheelchair user capacity was quantified as functional strength (maximum resultant force reached during maximum isometric forward push) and anaerobic work capacity (highest power output reached during 15-m sprint test). Multilevel mixed-effects linear regression analyses controlling for between subject variability and covariables were performed to address the research questions.ResultsAHD was significantly smaller during personal WRL (p < 0.001) and instructed WRL (p = 0.009, AHD both 11.5 mm) compared to the unloaded position (11.9 mm). A higher wheelchair user capacity (higher anaerobic work capacity) reduced the impact of WRL on AHD decrease. The fatiguing wheelchair propulsion had no effect on AHD (p = 0.570) and on OccRatio of supraspinatus (p = 0.404) and biceps (p = 0.448). Subject characteristics related to a larger subacromial space were lower lesion level, shorter time since injury, impaired external rotation, a lower body mass index and a higher anaerobic work capacity.ConclusionThis study showed a significant reduction in AHD during WRL with no effect of fatiguing wheelchair propulsion on the subacromial space in wheelchair users with SCI. A higher anaerobic work capacity was beneficial in stabilizing the shoulder during WRL. Our findings may assist clinicians in designing a shoulder injury prevention program.
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Affiliation(s)
- Ursina Arnet
- Shoulder Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- *Correspondence: Ursina Arnet
| | - Michael L. Boninger
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, University of Ghent, Ghent, Belgium
| | - Fransiska M. Bossuyt
- Shoulder Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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Jahanian O, Van Straaten MG, Barlow JD, Murthy NS, Morrow MMB. Progression of rotator cuff tendon pathology in manual wheelchair users with spinal cord injury: A 1-year longitudinal study. J Spinal Cord Med 2022; 46:466-476. [PMID: 35420535 PMCID: PMC10114966 DOI: 10.1080/10790268.2022.2057720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology. DESIGN Longitudinal cohort study, 1-year follow-up. SETTING Outpatient clinic at a tertiary medical center. PARTICIPANTS Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant. RESULTS Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort. CONCLUSION MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.
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Affiliation(s)
- Omid Jahanian
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Meegan G Van Straaten
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naveen S Murthy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa M B Morrow
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Pozzi F, Sousa CO, Plummer HA, Andrade B, Awokuse D, Kono N, Mack WJ, Roll SC, Michener LA. Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety. J Shoulder Elbow Surg 2022; 31:225-234. [PMID: 34656782 PMCID: PMC9121627 DOI: 10.1016/j.jse.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. METHODS We recruited dental hygiene (DH) students (n = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (n = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasonography, and psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog scale for pain score greater than the minimal clinically important difference) between DH and OT students using Fisher exact test. We used mixed effects models to longitudinally compare the change in outcomes between 3 groups: DH students who develop and did not develop shoulder pain, and OT students. RESULTS The incidence of shoulder pain is higher in DH students (relative risk = 4.0, 95% confidence interval [CI] 1.4, 11.4). After 1 year, DH students with pain had the greatest thickening of the supraspinatus (0.7 mm, 95% CI 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4 mm, 95% CI 0.1, 0.8) and OT students (0.9 mm, 95% CI 0.5, 1.2). Anxiety score increased 3.8 points (95% CI 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at 1 year (relative risk = 2.9, 95% CI 1.0, 8.6). CONCLUSION Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and it thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.
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Affiliation(s)
- Federico Pozzi
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
| | - Catarina O Sousa
- Departemento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Hillary A Plummer
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
| | - Brittany Andrade
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
| | - Naoko Kono
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A Michener
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
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21
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Jahanian O, Van Straaten MG, Goodwin BM, Cain SM, Lennon RJ, Barlow JD, Murthy NS, Morrow MMB. Inertial Measurement Unit-Derived Ergonomic Metrics for Assessing Arm Use in Manual Wheelchair Users With Spinal Cord Injury: A Preliminary Report. Top Spinal Cord Inj Rehabil 2021; 27:12-25. [PMID: 34456543 PMCID: PMC8370702 DOI: 10.46292/sci20-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Individuals with spinal cord injury (SCI) who use manual wheelchairs (MWCs) have a higher rate of rotator cuff pathology progression than able-bodied individuals. Objectives: This study aimed to test the ability of risk and recovery metrics of arm use to differentiate between (1) MWC users with SCI and matched able-bodied participants (cross-sectional matched-sample study) and (2) MWC users with rotator cuff pathology progression over 1 year from those without pathology progression (longitudinal study). Methods: Thirty-four MWC users and 34 age- and sex-matched able-bodied individuals were recruited. Upper arm risk (humeral elevation >60°) and recovery (static ≥5 seconds and humeral elevation <40°) metrics were calculated from wireless inertial measurement units (IMUs) worn on the upper arms and torso in the free-living environment. Two separate magnetic resonance imaging studies were completed and assessed for a subset of 16 MWC users approximately 1 year apart. Results: The frequency of risk events (p = .019), summated duration of recovery events (p = .025), and duration of each recovery event (p = .003) were higher for MWC users than able-bodied participants. The summated duration of risk events (p = .047), frequency of risk events (p = .027), and risk to recovery ratio (p = .02) were higher and the summated duration of recovery events (p = .036) and frequency of recovery events (p = .047) were lower for MWC users with rotator cuff pathology progression (n = 5) compared to those without progression (n = 11). Conclusion: IMU-derived metrics quantifying arm use at postures >60° and risk to recovery ratios may provide insights of potential risk factors for rotator cuff pathology progression.
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Affiliation(s)
- Omid Jahanian
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Meegan G Van Straaten
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Brianna M Goodwin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Stephen M Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | | | - Melissa M B Morrow
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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22
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Boland K, Smith C, Bond H, Briggs S, Walton J. Current concepts in the rehabilitation of rotator cuff related disorders. J Clin Orthop Trauma 2021; 18:13-19. [PMID: 33987078 PMCID: PMC8082254 DOI: 10.1016/j.jcot.2021.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 02/06/2023] Open
Abstract
Rotator cuff related disorders (RCRD) are common. Exercise-based rehabilitation can improve outcomes, yet uncertainty exists regarding the characteristics of these exercises. This scoping review paper summarises the key characteristics of the exercise-based rehabilitation of rotator cuff related disorders (RCRD). An iterative search process was used to capture the breadth of current evidence and a narrative summary of the data was produced. 57 papers were included. Disagreement around terminology, diagnostic standards, and outcome measures limits the comparison of the data. Rehabilitation should utilise a biopsychosocial approach, be person-centred and foster self-efficacy. Biomedically framed beliefs can create barriers to rehabilitation. Pain drivers in RCRSD are unclear, as is the influence of pain during exercise on outcomes. Expectations and preferences around pain levels should be discussed to allow the co-creation of a programme that is tolerated and therefore engaged with. The optimal parameters of exercise-based rehabilitation remain unclear; however, programmes should be individualised and progressive, with a minimum duration of 12 weeks. Supervised or home-based exercises are equally effective. Following rotator cuff repair, rehabilitation should be milestone-driven and individualised; communication across the MDT is essential. For individuals with massive rotator cuff tears, the anterior deltoid programme is a useful starting point and should be supplemented by functional rehabilitation, exercises to optimise any remaining cuff and the rest of the kinetic chain. In conclusion, exercise-based rehabilitation improves outcomes for individuals with a range of RCRD. The optimal parameters of these exercises remain unclear. Variation exists across current physiotherapy practice and post-operative rehabilitation protocols, reflecting the wide-ranging spectrum of individuals presenting with RCRD. Clinicians should use their communication and rehabilitation expertise to plan an exercise-based program in conjunction with the individual with RCRSD, which is regularly reviewed and adjusted.
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Affiliation(s)
- Katy Boland
- Upper Limb Department, Wrightington Hospital, Wigan, UK
| | - Claire Smith
- Upper Limb Department, Wrightington Hospital, Wigan, UK
| | - Helena Bond
- Upper Limb Department, Wrightington Hospital, Wigan, UK
| | - Sarah Briggs
- Upper Limb Department, Wrightington Hospital, Wigan, UK
| | - Julia Walton
- Upper Limb Department, Wrightington Hospital, Wigan, UK
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23
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Baek S, Ki SY, Chung SW, Lee SJ, Cho YC, Oh KS. Delayed Anticipatory Muscle Activation in Rotator Cuff Tendinopathy. Orthop J Sports Med 2021; 9:23259671211019360. [PMID: 34377717 PMCID: PMC8330462 DOI: 10.1177/23259671211019360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous research investigating rotator cuff (RC) tendinopathy has usually focused on pathoanatomy. The pathologic response to anticipatory postural adjustments (APAs) has not yet been investigated. PURPOSE/HYPOTHESIS To explore changes in APAs as detected by pre-emptive activation of shoulder muscles during ball catching. It was hypothesized that anticipatory muscle activation (AMA) would be present in the unaffected shoulder but delayed or absent in the affected shoulder in patients with RC tendinopathy. STUDY DESIGN Controlled laboratory study. METHODS This study included 21 RC tendinopathy patients with a mean age of 49.5 years. Patients were required to grab a ball embedded with an electromyography sensor when it dropped on their hand, and surface electromyography signals were recorded from the infraspinatus, upper trapezius, anterior deltoid, and biceps. The trials utilized 2 balls, weighing 200 g and 500 g. Each ball was used in 2 trials, 1 involving a number count preceding the ball drop (predictable) and the other involving a sudden drop (unpredictable). The onsets of AMA between the affected and unaffected limbs were compared. RESULTS Regardless of the experimental condition, significantly delayed AMA onsets were identified in all investigated muscles of the affected side compared with those of the unaffected side, except for the biceps muscle in the 500-g predictable trial. For the infraspinatus, the mean onset time in the 200-g predictable trial was -141.0 ± 60.2 ms on the affected side and -211.9 ± 67.1 ms on the unaffected side (P < .001); in the 200-g unpredictable trial this value was -139.5 ± 54.9 ms on the affected side and -199.5 ± 56.2 ms on the unaffected side (P < .001). CONCLUSION Delayed AMA was observed in the affected shoulder compared with the unaffected shoulder in patients with RC tendinopathy, not only in the RC muscle but also in the periscapular and upper arm muscles. This may indicate that central hypoexcitability is partly responsible. CLINICAL RELEVANCE The basis for RC tendinopathy treatment should not be limited to the tendon pathoanatomy. Delayed AMA around the shoulder joint could provide insight into potential mechanisms related to the central nervous system.
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Affiliation(s)
- Samuel Baek
- Department of Orthopaedic Surgery, Seoul Red Cross Hospital, Seoul, Republic of Korea
| | - Se-Young Ki
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seoung-Joon Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Chang Cho
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
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24
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Slagers AJ, van Veen E, Zwerver J, Geertzen JHB, Reininga IHF, van den Akker-Scheek I. Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study. Phys Ther Sport 2021; 50:145-152. [PMID: 34015607 DOI: 10.1016/j.ptsp.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function. DESIGN cross-sectional study. SETTING online survey platform. PARTICIPANTS 119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy. MAIN OUTCOME MEASURES A range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders. RESULTS Psychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction. CONCLUSION The current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.
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Affiliation(s)
- Anton J Slagers
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, the Netherlands.
| | - Esther van Veen
- University of Groningen, University Medical Center Groningen, Department of Orthopaedics, Groningen, the Netherlands.
| | - Johannes Zwerver
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Gelderse Vallei Hospital, Sports Valley, Department of Sports Medicine, Ede, the Netherlands.
| | - Jan H B Geertzen
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, the Netherlands.
| | - Inge H F Reininga
- University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands.
| | - Inge van den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Department of Orthopaedics, Groningen, the Netherlands.
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25
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Goodwin BM, Jahanian O, Cain SM, Van Straaten MG, Fortune E, Morrow MM. Duration of Static and Dynamic Periods of the Upper Arm During Daily Life of Manual Wheelchair Users and Matched Able-Bodied Participants: A Preliminary Report. Front Sports Act Living 2021; 3:603020. [PMID: 33842878 PMCID: PMC8034231 DOI: 10.3389/fspor.2021.603020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Manual wheelchair (MWC) users with spinal cord injuries (SCI) are at a significantly higher risk of experiencing rotator cuff pathology than able-bodied individuals. A deeper understanding of where the arm is used dynamically within the humeral workspace during daily life may help explain why MWC users have higher shoulder pathology rates than able-bodied individuals. The purpose of this study was to report the daily percentage and consecutive durations MWC users and matched able-bodied individuals (controls) spent static and dynamic across the humeral elevation workspace. Methods: MWC users with SCI and controls wore three inertial measurement units on their bilateral arms and torso for 1 or 2 days. The percentages of time and average consecutive duration individuals were static or dynamic while in five humeral elevation ranges (0-30°, 30-60°, 60-90°, 90-120°, and >120°) were calculated and compared between cohorts. Results: Forty-four MWC users (10 females, age: 42.8 ± 12.0, time since injury: 12.3 ± 11.5) and 44 age- and sex-matched controls were enrolled. The MWC cohort spent significantly more time dynamic in 60-90° (p = 0.039) and 90-120° (p = 0.029) and had longer consecutive dynamic periods in 30-60° (p = 0.001), 60-90° (p = 0.027), and 90-120° (p = 0.043) on the dominant arm. The controls spent significantly more time dynamic in 0-30° of humeral elevation (p < 0.001) on both arms. Although the average consecutive static durations were comparable between cohorts across all humeral elevation ranges, the MWC cohort spent a significantly higher percentage of their day static in 30-60° of humeral elevation than controls (dominant: p = 0.001, non-dominant: p = 0.01). The MWC cohort had a moderate association of increased age with decreased time dynamic in 30-60° for both arms. Discussion: Remote data capture of arm use during daily life can aid in understanding how arm function relates to shoulder pathology that follows SCI and subsequent MWC use. MWC users spent more time dynamic in higher elevations than controls, and with age, dynamic arm use decreased in the 30-60° humeral elevation range. These results may exemplify effects of performing activities from a seated position and of age on mobility.
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Affiliation(s)
- Brianna M. Goodwin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Omid Jahanian
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Stephen M. Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Meegan G. Van Straaten
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Emma Fortune
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Melissa M. Morrow
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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26
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Dominguez-Romero JG, Jiménez-Rejano JJ, Ridao-Fernández C, Chamorro-Moriana G. Exercise-Based Muscle Development Programmes and Their Effectiveness in the Functional Recovery of Rotator Cuff Tendinopathy: A Systematic Review. Diagnostics (Basel) 2021; 11:529. [PMID: 33809604 PMCID: PMC8002167 DOI: 10.3390/diagnostics11030529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Rotator cuff (RC) tendinopathy causes pain and functional limitation of the shoulder. Physical exercises are effective therapies but there is no consensus on which exercise programme is the most appropriate. Objective: To analyze and compare the effectiveness of different intervention modalities-based exclusively on physical exercise muscle-development programs to improve shoulder pain and function in RC tendinopathy. (2) Methods: Systematic review (PRISMA) through a search in PubMed, WOS, PEDro, Cinahl, Scopus and Dialnet. The PEDro Scale and the Cochrane Risk of Bias analyzed the methodological quality. A pre-established table collected data on: patients, interventions, outcome measures and results. A narrative synthesis of the results was conducted. (3) Results: eight articles were selected (Cochrane: low risk of bias; PEDro: good quality). All assessed programs were effective. Only one study found statistically and clinically significant differences in favour of eccentric training. The exercises used were: eccentric/concentric/conventional, open/closed kinetic chain, with/without co-activation of glenohumeral muscle, with/without pain, and in clinic/at home. (4) Conclusions: All exercise programs were effective in RC tendinopathy, improving pain and shoulder function. No solid results were obtained when the interventions were compared due to their heterogeneity. Patients perception assessment tools were the most widely used. Amount of load applied should be considered.
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Affiliation(s)
| | | | | | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, University of Seville, 41009 Seville, Spain; (J.G.D.-R.); (J.J.J.-R.); (C.R.-F.)
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27
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Navarro-Ledesma S, Gonzalez-Muñoz A. Short-term effects of 448 kilohertz radiofrequency stimulation on supraspinatus tendon elasticity measured by quantitative ultrasound elastography in professional badminton players: a double-blinded randomized clinical trial. Int J Hyperthermia 2021; 38:421-427. [PMID: 33691576 DOI: 10.1080/02656736.2021.1896790] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To study changes in supraspinatus tendon elasticity after a 448 kHz capacitive resistive monopolar radiofrequency (CRMR) intervention in professional badminton players. DESIGN Double-blinded randomized clinical trial. SETTING All participants were recruited in a private care practice. Participants were randomized to receive either a CRMR treatment (n = 19) or placebo (n = 19). SUBJECTS Professional badminton players (n = 38). INTERVENTION A total of nine intervention (three per week) with CRMR at 448 kHz were carried out in the experimental group. The same intervention without an active CRMR current was carried out in the control group. MAIN MEASURES Mean values of three different regions of the supraspinatus tendon were reported at baseline (T1), immediately after the intervention (T2) and one week after the end of the whole intervention program (T3) using quantitative ultrasound strain elastography (SEL). RESULTS There were statistically significant differences in the supraspinatus tendon elasticity immediately after the intervention (p= <.001) and one week after the end of the whole intervention program (p=.001). CONCLUSION CRMR at 448 kHz produces significant changes in supraspinatus tendon elasticity after an intervention program of three weeks and those changes last for a week when compared to control group. Clinical trial registration: NCT04273633 (ClinicalTrials.gov).
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Larrivée S, Balg F, Léonard G, Bédard S, Tousignant M, Boissy P. Transcranial direct current stimulation (a-tCDS) after subacromial injections in patients with subacromial pain syndrome: a randomized controlled pilot study. BMC Musculoskelet Disord 2021; 22:265. [PMID: 33706729 PMCID: PMC7948354 DOI: 10.1186/s12891-021-04139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subacromial pain syndrome (SAPS) is a common complaint in orthopaedics. Subacromial corticosteroid injections (CSI) can relieve pain in the short term. Anodal transcranial direct current stimulation (a-tDCS) has been used for symptomatic pain relief in a variety of chronic pain conditions. The aim of this pilot study was to assess whether the application a-tDCS could enhance the symptomatic relief provided by CSI in patients affected by SAPS. METHODS Thirty-eight participants (18 to 65-year-old) suffering from SAPS were recruited to have a CSI and randomly allocated to receive, 1 weeks post CSI, real a-tDCS (r-tDCS), sham tDCS (s-tDCS) or no intervention (Control). Upper limb function was measured 1 week prior to the CSI, at the 2- and 4-week follow-ups using self-administered questionnaires and physical measures. Self-reported pain and activity during each day were logged by the participants using visual analog scales (VAS). Differences between groups were tested using repeated-measures ANOVAs. RESULTS Pain VAS and the Single Assessment Numeric Evaluation scale (SANE) showed significant improvement from baseline 2 weeks and 4 weeks after CSI in all groups (p < 0.05). There were no significant group X time interaction 2 weeks following tDCS treatment in any of the variables. CONCLUSION All groups showed significant improvement in pain VAS and SANE scores following the CSI. One session of a-tDCS treatment 2 weeks following CSI did not result in any additive or potentializing effects when compared to a s-tDCS or a control group. TRIAL REGISTRATION ClinicalTrials.gov, NCT03967574 . Registered 30 May 2019 - Retrospectively registered.
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Affiliation(s)
- Samuel Larrivée
- Research Center on Aging CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
- Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédéric Balg
- Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center CRCHUS, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Research Center on Aging CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sonia Bédard
- Research Center CRCHUS, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
| | - Michel Tousignant
- Research Center on Aging CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick Boissy
- Research Center on Aging CIUSSS Estrie CHUS, Sherbrooke, QC, Canada.
- Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Research Center CRCHUS, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada.
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Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A. Differences in supraspinatus occupation ratio between the symptomatic, the contralateral asymptomatic shoulder and control subjects: A cross-sectional study. Medicine (Baltimore) 2021; 100:e24734. [PMID: 33578621 PMCID: PMC10545080 DOI: 10.1097/md.0000000000024734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT The relationship between supraspinatus tendon thickness and the acromiohumeral distance (AHD) at both rest position and shoulder elevation is still to be explored in those with chronic shoulder pain. The aim is to compare supraspinatus occupation ratio (OR) at 0° and 60° of shoulder elevation measured by ultrasound imaging in the symptomatic shoulder, the contralateral asymptomatic shoulder and in healthy subjects. This was across-sectional, observational study. A sample of 56 participants with subacromial pain syndrome in their dominant arm was recruited in 3 different primary care centres. Forty participants without shoulder pain were also recruited. The AHD at 0° and 60° of active shoulder abduction as well as the supraspinatus tendon thickness were measured by ultrasound in these groups. Supraspinatus OR at 60° was significantly greater in symptomatic compared to asymptomatic shoulders (P = .04) and healthy shoulders (P = .008). The percentage of change in supraspinatus OR from rest position to 60° was also greater in symptomatic shoulders when comparing with asymptomatic (P = .01) and healthy shoulders (P = .03). No other statistically significant differences for the rest of comparisons were found. Supraspinatus OR may explain shoulder pain in chronic conditions. Further studies at acute and chronic conditions after a physiotherapy treatment are needed to explore its usefulness in clinical practice.
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Affiliation(s)
| | - Manuel Fernandez-Sanchez
- Department of Nursing Physiotherapy and Medicine, University of Almeria, Facultad Ciencias de la Salud, Universidad de Almería, Ctra de Sacramento S/N, Almeria
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga, Spain. Facultad Ciencias de la Salud, Universidad de Malaga, Arquitecto Francisco Penalosa, 3, Malaga
- Instituto de la Investigacion Biomedica de Malaga-IBIMA, Spain
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No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis. Sci Rep 2020; 10:20611. [PMID: 33244115 PMCID: PMC7693267 DOI: 10.1038/s41598-020-76704-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome (SAPS) and those without. To investigate whether there is a correlation between subacromial space and pain or disability in adults with SAPS and whether temporal changes in pain or disability are accompanied by changes in subacromial space. Systematic review and meta-analysis. Fifteen studies with a total of 775 participants were included. Twelve studies were of high quality and three studies were of moderate quality using the modified Black and Downs checklist. There was no between group difference in AHD in neutral shoulder position (mean difference [95% CI] 0.28 [−0.13 to 0.69] mm), shoulder abduction at 45° (−0.02 [−0.99 to 0.96] mm) or 60° (−0.20 [−0.61 to 0.20] mm). Compared to the control group, a greater occupation ratio in neutral shoulder position was demonstrated in participants with SAPS (5.14 [1.87 to 8.4] %). There was no consistent pattern regarding the correlation between AHD and pain or disability in participants with SAPS, and no consistent increase in subacromial space with improvement in pain or disability over time. The results suggest that surgical (e.g. sub-acromial decompression) and non-surgical (e.g. manual therapy, taping, stretching and strengthening) management of subacromial pain syndrome should not focus solely on addressing a potential decrease in subacromial space, but also on the importance of other biopsychosocial factors.
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Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial. Am J Phys Med Rehabil 2020; 99:504-513. [PMID: 31851011 DOI: 10.1097/phm.0000000000001362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury. DESIGN The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale. RESULTS Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study. CONCLUSIONS Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics.
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Jenkins PJ, Stirling PHC, Ireland J, Elias-Jones C, Brooksbank AJ. The changing incidence of arthroscopic subacromial decompression in Scotland. Bone Joint J 2020; 102-B:360-364. [DOI: 10.1302/0301-620x.102b3.bjj-2019-0752.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location. Methods Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent acromioclavicular joint excision (ACJE) and rotator cuff repair (RCR) were identified and grouped separately. Procedure rates were age and sex standardized against the European standard population. Results During the study period the number of ASDs fell by 649 cases (29%) from 2,217 in the first year to 1,568 in the final year. The standardized annual procedure rate fell from 41.6 (95% confidence interval (CI) 39.9 to 43.4) to 28.9 (95% CI 27.4 to 30.3) per 100,000. The greatest reduction occurred between 2017 and 2018. The number of ACJEs rose from 41 to 188 (a 3.59-fold increase). The number of RCRs fell from 655 to 560 (-15%). In the year 2017 to 2018 there were four (28.6%) Scottish NHS board areas where the ASD rate was greater than 3 standard deviations (SDs) from the national average, and two (14.3%) NHS boards where the rate was less than 3 SDs from the national average. Conclusion There has been a clear decline in the rate of ASD in Scotland since 2014. Over the same period there has been an increase in the rate of ACJE. The greatest decline occurred between 2017 and 2018, corresponding to the publication of epidemiological studies demonstrating a rise in ASD, and awareness of studies which questioned the benefit of ASD. This paper demonstrates the potential impact of information from epidemiological studies, referral guidelines, and well-designed large multicentre randomized controlled trials on clinical practice. Cite this article: Bone Joint J 2020;102-B(3):360–364
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Larrivée S, Balg F, Léonard G, Bédard S, Tousignant M, Boissy P. Wrist-Based Accelerometers and Visual Analog Scales as Outcome Measures for Shoulder Activity During Daily Living in Patients With Rotator Cuff Tendinopathy: Instrument Validation Study. JMIR Rehabil Assist Technol 2019; 6:e14468. [PMID: 31793896 PMCID: PMC6918212 DOI: 10.2196/14468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Shoulder pain secondary to rotator cuff tendinopathy affects a large proportion of patients in orthopedic surgery practices. Corticosteroid injections are a common intervention proposed for these patients. The clinical evaluation of a response to corticosteroid injections is usually based only on the patient's self-evaluation of his function, activity, and pain by multiple questionnaires with varying metrological qualities. Objective measures of upper extremity functions are lacking, but wearable sensors are emerging as potential tools to assess upper extremity function and activity. OBJECTIVE This study aimed (1) to evaluate and compare test-retest reliability and sensitivity to change of known clinical assessments of shoulder function to wrist-based accelerometer measures and visual analog scales (VAS) of shoulder activity during daily living in patients with rotator cuff tendinopathy convergent validity and (2) to determine the acceptability and compliance of using wrist-based wearable sensors. METHODS A total of 38 patients affected by rotator cuff tendinopathy wore wrist accelerometers on the affected side for a total of 5 weeks. Western Ontario Rotator Cuff (WORC) index; Short version of the Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH); and clinical examination (range of motion and strength) were performed the week before the corticosteroid injections, the day of the corticosteroid injections, and 2 and 4 weeks after the corticosteroid injections. Daily Single Assessment Numeric Evaluation (SANE) and VAS were filled by participants to record shoulder pain and activity. Accelerometer data were processed to extract daily upper extremity activity in the form of active time; activity counts; and ratio of low-intensity activities, medium-intensity activities, and high-intensity activities. RESULTS Daily pain measured using VAS and SANE correlated well with the WORC and QuickDASH questionnaires (r=0.564-0.815) but not with accelerometry measures, amplitude, and strength. Daily activity measured with VAS had good correlation with active time (r=0.484, P=.02). All questionnaires had excellent test-retest reliability at 1 week before corticosteroid injections (intraclass correlation coefficient [ICC]=0.883-0.950). Acceptable reliability was observed with accelerometry (ICC=0.621-0.724), apart from low-intensity activities (ICC=0.104). Sensitivity to change was excellent at 2 and 4 weeks for all questionnaires (standardized response mean=1.039-2.094) except for activity VAS (standardized response mean=0.50). Accelerometry measures had low sensitivity to change at 2 weeks, but excellent sensitivity at 4 weeks (standardized response mean=0.803-1.032). CONCLUSIONS Daily pain VAS and SANE had good correlation with the validated questionnaires, excellent reliability at 1 week, and excellent sensitivity to change at 2 and 4 weeks. Daily activity VAS and accelerometry-derived active time correlated well together. Activity VAS had excellent reliability, but moderate sensitivity to change. Accelerometry measures had moderate reliability and acceptable sensitivity to change at 4 weeks.
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Affiliation(s)
- Samuel Larrivée
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.,Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédéric Balg
- Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of CHUS, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sonia Bédard
- Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of CHUS, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Michel Tousignant
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick Boissy
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.,Department of Surgery, Division of Orthopedics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of CHUS, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Barrett E, Conroy C, Corcoran M, Sullivan KO, Purtill H, Lewis J, McCreesh K. An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series. J Hand Ther 2019; 31:301-307. [PMID: 29217293 DOI: 10.1016/j.jht.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A case series was carried out. INTRODUCTION There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. PURPOSE OF THE STUDY To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. METHODS People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. RESULTS Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P < .001). Effect sizes ranged from 0.78-1.16 in the shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. DISCUSSION/CONCLUSION Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture.
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Affiliation(s)
- Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Carmela Conroy
- Physiotherapy Department, St. John's Hospital, Limerick, Ireland
| | - Marie Corcoran
- Physiotherapy Department, Midland Regional Hospital, Portlaoise, Ireland
| | - Kieran O' Sullivan
- Sports Spine Centre, Aspetar Sports and Orthopaedic Hospital, Doha, Qatar
| | - Helen Purtill
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Jeremy Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland; Department of Allied Health Professions and Midwifery, University of Hertfordshire, Hertfordshire, UK; Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK
| | - Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
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Kaplan K, Olivencia O, Dreger M, Hanney WJ, Kolber MJ. Achilles Tendinopathy: An Evidence-Based Overview for the Sports Medicine Professional. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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36
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Yang L, Tang C, Chen Y, Ruan D, Zhang E, Yin Z, Chen X, Jiang Y, Cai Y, Fei Y, Zhu S, Liu H, Hu J, Heng BC, Chen W, Shen W, Ouyang H. Pharmacological Inhibition of Rac1 Activity Prevents Pathological Calcification and Enhances Tendon Regeneration. ACS Biomater Sci Eng 2019; 5:3511-3522. [PMID: 33405734 DOI: 10.1021/acsbiomaterials.9b00335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tendinopathy is a common disease, which is characterized by pain, swelling, and dysfunction. At the late stage of tendinopathy, pathological changes may occur, such as tendon calcification. Previously, we have shown that in situ tendon stem/progenitor cells (TSPCs) underwent osteogenesis in the inflammatory niche in diseased tendons. In this study, we demonstrate that this process is accompanied by the activation of Ras-related C3 botulinum toxin substrate 1 (Rac1) signaling. A specific inhibitor NSC23766 significantly downregulated catabolic factors and calcification-related genes and rescued the tenogenesis gene expression of TSPCs under the influence of Interleukin (IL)-1β in vitro. For in vivo evaluation, we further developed a drug delivery system to encapsulate Rac1 inhibitor NSC23766. Chitosan/β-glycerophosphate hydrogel encapsulated NSC23766 effectively impeded tendon calcification and enhanced tendon regeneration in rat Achilles tendinosis. Our findings indicated that inhibiting Rac1 signaling could act as an effective intervention for tendon pathological calcification and promote tendon regeneration, thus providing a new therapeutic strategy.
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Affiliation(s)
- Long Yang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenqi Tang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Orthopaedics, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Yangwu Chen
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Orthopaedics, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopaedics, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Erchen Zhang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zi Yin
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao Chen
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
| | - Yangzi Jiang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - Youzhi Cai
- Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,Center for Sport Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Fei
- Department of Orthopaedics, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shouan Zhu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huanhuan Liu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiajie Hu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Faculty of Dentistry, Department of Endodontology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Weishan Chen
- Department of Orthopaedics, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Weiliang Shen
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Orthopaedics, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou, China.,China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China.,Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongwei Ouyang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.,China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China.,Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Navarro-Ledesma S, Struyf F, Falla D, Luque-Suarez A. Non-traumatic chronic shoulder pain is not associated with changes in rotator cuff interval tendon thickness. Clin Biomech (Bristol, Avon) 2019; 63:147-152. [PMID: 30897462 DOI: 10.1016/j.clinbiomech.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether the thickness of the rotator interval tendons is different when comparing both symptomatic and non-symptomatic sides in people with chronic shoulder pain, and to those free of pain. Furthermore, to calculate the level of association between the rotator interval tendon thicknesses and perceived shoulder pain-function. DESIGN A cross-sectional, observational study. METHOD The supraspinatus, subscapularis and biceps brachii tendon thickness of sixty two patients with chronic shoulder pain were determined from standardized ultrasonography measures performed on both shoulders, whereas only the dominant arm was measured for the control subjects. FINDINGS Supraspinatus, subscapularis and biceps brachii tendon thickness was comparable between sides in the symptomatic group and was also comparable between the symptomatic and asymptomatic participants. In addition, the correlation between the tendon thickness and shoulder pain-function was non-significant. INTERPRETATIONS Tendon thickness was unaltered in people with chronic shoulder pain. These findings do not rule out the possibility that other changes in the tendon are present such as changes in the elastic properties and cell population and this should be explored in future studies.
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Affiliation(s)
- S Navarro-Ledesma
- Department of Physiotherapy, University of Granada, Melilla, Querol Street, 5, 52004 Melilla, Spain; Department of Physiotherapy, University of Malaga, Spain.
| | - F Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, United Kingdom
| | - A Luque-Suarez
- Department of Physiotherapy, University of Malaga, Spain
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Sole G, Mącznik AK, Ribeiro DC, Jayakaran P, Wassinger CA. Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study. Disabil Rehabil 2019; 42:1870-1879. [PMID: 30634871 DOI: 10.1080/09638288.2018.1542037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session.Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach.Results: There were two over-arching key themes: firstly, 'Participants' Perspectives' of the session generated four themes: Improved understanding of 'the whole'; Mindful self-awareness; Taking charge; "The pain is still there". Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, 'Participants' Recommendations', had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education.Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Aleksandra K Mącznik
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, USA
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Assessment of ultrasonography as a diagnostic tool in shoulder pain and alterations in glenohumeral range of motion in tennis players. Wideochir Inne Tech Maloinwazyjne 2019; 14:114-125. [PMID: 30766638 PMCID: PMC6372869 DOI: 10.5114/wiitm.2018.81183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/22/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction Shoulder pain and alterations in the range of motion are common disorders in tennis players. However, the relation between shoulder structures and these conditions is unknown. Aim To evaluate whether, using ultrasonography, one can identify tennis players with shoulder pain and those having specific changes of the range of rotation of the glenohumeral joint. Material and methods A total of 66 subjects were assessed through examination of the range of rotation of the glenohumeral joint and ultrasonography. Results The study group consisted of 37 people with shoulder pain (24.2 ±8.6 years) and the control group included 29 subjects without shoulder pain (21.9 ±10.8 years). The prevalence of pathologies of the supraspinatus (SSP), infraspinatus (ISP) or subscapularis (SSC) was significantly higher in the study group than in the control group (p = 0.044) but solely for the combined pathologies. The incidence rate of pathological shoulder changes (the SSP, ISP, SSC and the subacromial bursa) was not correlated with the ranges of rotations or intensity of pain. Glenohumeral internal rotation deficit (GIRD), total rotational motion (TROM) deficit and external rotation deficiency (ERD) were independent of pathological shoulder changes, except the significantly higher prevalence of SSP pathologies among subjects with ERD. Conclusions Ultrasonography could be helpful in identifying tennis players with painful shoulder having rotator cuff pathologies. However, the ability of the method to identify players having specific changes of the range of rotation of the glenohumeral joint is limited, with the exception of tennis players with ERD having SSP pathologies.
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Dupuis F, Barrett E, Dubé MO, McCreesh KM, Lewis JS, Roy JS. Cryotherapy or gradual reloading exercises in acute presentations of rotator cuff tendinopathy: a randomised controlled trial. BMJ Open Sport Exerc Med 2018; 4:e000477. [PMID: 30622733 PMCID: PMC6307582 DOI: 10.1136/bmjsem-2018-000477] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/28/2022] Open
Abstract
Objectives Rotator cuff tendinopathies are the most common shoulder disorders. As persistent symptoms lasting more than 3 months have been shown to be a strong indicator of poor outcomes, it is important to have successful interventions in the acute stage. However, there is no evidence yet to guide clinical interventions in an acute pain context. The objective of this study was to compare the short-term effect of a 2-week gradual reloading exercises programme with the use of cryotherapy on symptoms and function for acute rotator cuff tendinopathy. Methods This simple-blind, randomised controlled trial included 44 participants with acute rotator cuff tendinopathy who were randomly allocated to either the exercises or cryotherapy group. Symptoms and functional limitations were evaluated at weeks 0, 2 and 6 using self-reported questionnaires (Disabilities of the Arm, Shoulder and Hand, Western Ontario Rotator Cuff, and Brief Pain Inventory), while acromiohumeral distance, shoulder strength and active range of motion were evaluated at weeks 0 and 2. Results Following interventions, both groups showed statistically significant improvements on symptoms and function at week 2 and week 6 compared with baseline. However, there was no significant group × time interaction. There was no time effect on acromiohumeral distance, shoulder strength and active range of motion, as well as no time × group interaction. Conclusion The results showed a statistically significant improvement in symptoms and function in both groups, but there was no difference between the short-term effect of a cryotherapy based-approach and a gradual reloading exercises programme. Trial registration number NCT02813304.
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Affiliation(s)
- Frédérique Dupuis
- Faculty of Medicine, Laval University, Quebec City, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
| | - Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Marc-Olivier Dubé
- Faculty of Medicine, Laval University, Quebec City, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
| | - Karen M McCreesh
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jeremy S Lewis
- Department of Allied Health Professions and Midwifery, School of Health and Social Work, University of Hertfordshire, Hatfield, UK.,Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
| | - Jean-Sébastien Roy
- Faculty of Medicine, Laval University, Quebec City, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
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Kaplan K, Hanney WJ, Cheatham SW, Masaracchio M, Liu X, Kolber MJ. Rotator Cuff Tendinopathy: An Evidence-Based Overview for the Sports Medicine Professional. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Cook T, Minns Lowe C, Maybury M, Lewis JS. Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review. Br J Sports Med 2018; 52:497-504. [DOI: 10.1136/bjsports-2016-097444] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/04/2022]
Abstract
ObjectiveTo compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP).DesignSystematic review with best evidence synthesis.Data sourcesThe Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched.Eligibility criteriaTwo reviewers independently evaluated eligibility. Randomised controlled trials (RCTs) were included if they compared subacromial injections of corticosteroid with anaesthetic injections. Two reviewers independently extracted data regarding short-term, midterm and long-term outcomes for pain, self-reported function, range of motion and patient-perceived improvement.ResultsThirteen RCTs (n=1013) were included. Four trials (n=475) were judged as being at low risk of bias. Three studies of low risk of bias favoured the use of corticosteroid over anaesthetic-only injections in the short term (up to 8 weeks). There was strong evidence of no significant difference between injection types in midterm outcomes (12–26 weeks). There was limited evidence of no significant difference between injection types in long-term outcomes.ConclusionCorticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of RCRSP. Beyond 8 weeks, there was no evidence to suggest a benefit of corticosteroid over local anaesthetic injections.Trial registration numberPROSPERO CRD42016033161.
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43
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Roos TR, Roos AK, Avins AL, Ahmed MA, Kleimeyer JP, Fredericson M, Ioannidis JPA, Dragoo JL, Kim SK. Genome-wide association study identifies a locus associated with rotator cuff injury. PLoS One 2017; 12:e0189317. [PMID: 29228018 PMCID: PMC5724859 DOI: 10.1371/journal.pone.0189317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/22/2017] [Indexed: 01/10/2023] Open
Abstract
Rotator cuff tears are common, especially in the fifth and sixth decades of life, but can also occur in the competitive athlete. Genetic differences may contribute to overall injury risk. Identifying genetic loci associated with rotator cuff injury could shed light on the etiology of this injury. We performed a genome-wide association screen using publically available data from the Research Program in Genes, Environment and Health including 8,357 cases of rotator cuff injury and 94,622 controls. We found rs71404070 to show a genome-wide significant association with rotator cuff injury with p = 2.31x10-8 and an odds ratio of 1.25 per allele. This SNP is located next to cadherin8, which encodes a protein involved in cell adhesion. We also attempted to validate previous gene association studies that had reported a total of 18 SNPs showing a significant association with rotator cuff injury. However, none of the 18 SNPs were validated in our dataset. rs71404070 may be informative in explaining why some individuals are more susceptible to rotator cuff injury than others.
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Affiliation(s)
- Thomas R. Roos
- Department of Developmental Biology, Stanford University Medical Center, Stanford, CA, United States of America
- Department of Health Research and Policy, Division of Epidemiology, Stanford University Medical Center, Stanford, CA, United States of America
| | - Andrew K. Roos
- Department of Developmental Biology, Stanford University Medical Center, Stanford, CA, United States of America
- Department of Health Research and Policy, Division of Epidemiology, Stanford University Medical Center, Stanford, CA, United States of America
| | - Andrew L. Avins
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America
| | - Marwa A. Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
| | - John P. Kleimeyer
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| | - John P. A. Ioannidis
- Department of Medicine, Stanford Prevention Research Center and Dept. of Health Research and Policy, Division of Epidemiology, Stanford University School of Medicine, and Dept. of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, United States of America
| | - Jason L. Dragoo
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| | - Stuart K. Kim
- Department of Developmental Biology, Stanford University Medical Center, Stanford, CA, United States of America
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44
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SHOULDER EXTERNAL ROTATOR ECCENTRIC TRAINING VERSUS GENERAL SHOULDER EXERCISE FOR SUBACROMIAL PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL. Int J Sports Phys Ther 2017; 12:1121-1133. [PMID: 29234564 DOI: 10.26603/ijspt20171121] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Shoulder pain affects up to 67% of the population at some point in their lifetime with subacromial pain syndrome (SAPS) representing a common etiology. Despite a plethora of studies there remains conflicting evidence for appropriate management of SAPS. Purpose To compare outcomes, for individuals diagnosed with SAPS, performing a 6-week protocol of eccentric training of the shoulder external rotators (ETER) compared to a general exercise (GE) protocol. Study Design Randomized controlled trial. Methods Forty-eight individuals (mean age 46.8 years + /-17.29) with chronic shoulder pain, and a clinical diagnosis of SAPS were randomized into either an experimental group performing ETER or a control group performing a GE program. The intervention lasted for six weeks, and outcomes were measured after three weeks, six weeks, and again at six months post intervention. Results The primary outcome of function, measured by the Western Ontario Rotator Cuff Index, demonstrated a significant interaction effect derived from a multilevel hierarchical model accounting for repeated measures favoring the experimental group at week 3: 14.65 (p=.003), Week 6: 17.04 (p<.001) and six months: 15.12 (p=.007). After six months, secondary outcome measures were improved for Numeric Pain Rating Scale levels representing pain at worst (p=.006) and pain on average (p=0.02), external rotator (p<.001), internal rotator (p=0.02), and abductor strength (p<.001). There were no statistically significant differences in secondary outcome measures of Global Rating of Change, Active Range of Motion, the Upper Quarter Y Balance Test and strength ratios after six months. Conclusion An eccentric program targeting the external rotators was superior to a general exercise program for strength, pain, and function after six months. The findings suggest eccentric training may be efficacious to improve self-report function and strength for those with SAPS. Level of Evidence 2b.
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Kinsella R, Cowan SM, Watson L, Pizzari T. A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2017; 3:45. [PMID: 29163981 PMCID: PMC5684744 DOI: 10.1186/s40814-017-0190-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 09/26/2017] [Indexed: 01/10/2023] Open
Abstract
Background Subacromial pain syndrome (SPS) involving rotator cuff tendinopathy is a common cause of shoulder pain and disability. Evidence suggests that structured physiotherapy may be as effective as surgery in this condition with significant improvements demonstrated in trials involving scapular retraining, rotator cuff strengthening and flexibility exercises. Most published programs typically utilise isotonic concentric and/or eccentric strengthening modes. Recently, immediate analgesic effects and muscle strength gains following heavy-load isometric exercises in lower limb tendinopathy conditions have been observed. It is pertinent to ascertain whether such outcomes can be replicated in SPS/rotator cuff tendinopathy. The primary aim of this study is to establish the feasibility of undertaking a full-scale randomised controlled trial (RCT) that compares the effects of isometric, isotonic concentric and isotonic eccentric rotator cuff contractions when used as part of a semi-standardised exercise-based physiotherapy program in patients diagnosed with SPS. The secondary aim is to explore potential trends or treatment effects of the exercise intervention. Methods Thirty-six participants diagnosed with SPS will be randomised to one of three intervention groups and undergo a one-on-one exercise-based physiotherapy intervention, involving scapular and rotator cuff muscle retraining and strengthening. Each group will utilise a different mode of rotator cuff strengthening—isometric, isotonic concentric or isotonic eccentric. Rotator cuff tendon responses to isometric loading are not yet established in the literature; hence, individualised, progressive loading will be used in this pilot study in accordance with symptoms. The intervention will involve two phases: during Phase 1 (weeks 1–6) participants undertake the active group-specific physiotherapy treatment; in Phase 2 (weeks 6–12), they undertake a progressive, but no longer group-specific exercise program. To determine feasibility, an evaluation of key study parameters including (a) ease of recruitment (rate and number as well as suitability of the assessment algorithm), (b) adherence to all phases of the exercise intervention including home program compliance and logbook completion, (c) participant non-completion (drop out number and rate) and (d) adverse events (nature and number) will be undertaken. Secondary outcomes will measure immediate effects: (i) within-treatment changes in pain perception (verbal rating scale (VRS) and shoulder muscle strength (hand-held dynamometer) as well as longer-term changes: (ii) shoulder-related symptoms and disability (Western Ontario Rotator Cuff Index (WORC) and Shoulder Pain and Disability Index (SPADI)), (iii) perception of pain (11-point numerical rating scale (NRS), (iv) shoulder muscle strength (hand-held dynamometer) and (v) perceived global rating of change score. The immediate within-treatment assessment of pain and muscle strength will be undertaken in treatments 2 and 3, and the longer term measures will be collected at the primary (conclusion of Phase 1 at 6 weeks) and secondary (conclusion of Phase 2 at 12 weeks) end-points of the study. Discussion The findings of this pilot study will permit evaluation of this study design for a full-scale RCT. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001676404 Electronic supplementary material The online version of this article (10.1186/s40814-017-0190-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rita Kinsella
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Physiotherapy Department, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, Australia
| | - Sallie M Cowan
- Clifton Hill Physiotherapy, 111 Queens Parade, Clifton Hill, Melbourne, Australia.,University of Melbourne, School of Physiotherapy, Melbourne, Australia
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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46
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Gillespie MA, M Cznik A, Wassinger CA, Sole G. Rotator cuff-related pain: Patients' understanding and experiences. Musculoskelet Sci Pract 2017; 30:64-71. [PMID: 28582682 DOI: 10.1016/j.msksp.2017.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent musculoskeletal pain is a multi-factorial entity, influenced by biological, genetic and psychosocial factors. Psychosocial factors, such as individuals' beliefs and experiences, need to be considered in the management of such pain. While extensive research has explored beliefs of individuals with spinal pain, less is known about individuals' beliefs regarding shoulder pain. OBJECTIVES To explore beliefs about the cause of pain in individuals with persistent rotator cuff-related pain, as well as the experiences of the effect of pain on their daily lives. DESIGN A mixed methods design, using semi-structured interviews and validated outcome questionnaires. METHOD Five men and five women, aged 47-68 years, with shoulder pain for at least three months were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim and analysed using the general inductive approach. RESULTS/FINDINGS Four key themes emerged. The cause of pain, 'Understanding the pain', was described in terms of anatomical factors within the context of the participants' lives. The pain impacted all areas of life, creating another theme, 'It affects everything'. Participants responded to their pain by adopting certain, 'Pain-associated behaviours' and sought information for diagnosis, general management and exercise prescription, 'Emotional responses and the future'. CONCLUSIONS The participants with rotator cuff-related pain believed the cause of their pain to be local to the shoulder region. However, they also described various stressors in their work-, sports- and family-related lives. Rehabilitation may need to include educating the individual, expanding their understanding regarding pain mechanisms and appropriate interventions, based on individual goal-setting.
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Affiliation(s)
- Melissa A Gillespie
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Advance Wellness Centre, Hamilton, New Zealand
| | - Aleksandra M Cznik
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
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47
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Land H, Gordon S, Watt K. Reply to the letter to the Editor regarding 'Clinical assessment of subacromial shoulder impingement - Which factors differ from the asymptomatic population?'. Musculoskelet Sci Pract 2017; 29:e14-e15. [PMID: 28396212 DOI: 10.1016/j.msksp.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helen Land
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Susan Gordon
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Kerrianne Watt
- College of Public Health, Medical & Vet Sciences, James Cook University, Townsville, Queensland, Australia.
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48
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Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, Oliveira JM, Pereira H, Peretti GM, Romero-Rodriguez D, Spang C, Stephen J, van Bergen CJA, de Girolamo L. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. J Exp Orthop 2017; 4:18. [PMID: 28560707 PMCID: PMC5449348 DOI: 10.1186/s40634-017-0092-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/12/2017] [Indexed: 12/05/2022] Open
Abstract
Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.
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Affiliation(s)
- F Abat
- Department of Orthopaedic Sports Medicine, ReSport Clinic, Passeig Fabra i Puig 47, 08030, Barcelona, Spain.
| | - H Alfredson
- Sports Medicine Unit, University of Umeå, Umeå, Sweden.,Alfredson Tendon Clinic Inc, Umeå, Sweden.,Pure Sports Medicine Clinic, ISEH, UCLH, London, UK
| | - M Cucchiarini
- Molecular Biology, Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr Bldg 37, 66421, Homburg/Saar, Germany
| | - H Madry
- Lehrstuhl für Experimentelle Orthopädie und Arthroseforschung, Universität des Saarlandes, Gebäude 37, Kirrbergerstr 1, 66421, Homburg, Germany
| | - A Marmotti
- Department of Orthopaedics and Traumatology, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Turin, Italy
| | - C Mouton
- Department of Orthopedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - J M Oliveira
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Zona Industrial da Gandra, 4805-017, Barco, GMR, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - H Pereira
- 3B's Research Group University of Minho, ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal.,Orthopedic Department Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,Ripoll y De Prado Sports Clinic - FIFA Medical Centre of Excellence, Murcia, Madrid, Spain
| | - G M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Romero-Rodriguez
- Department of Physical Therapy and Sports Rehabilitation, ReSport Clinic Barcelona, Barcelona, Spain.,EUSES Sports Science, University of Girona, Girona, Spain
| | - C Spang
- Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden
| | - J Stephen
- Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.,The Biomechanics Group, Department of Mechanical Engineering, Imperial College, London, UK
| | - C J A van Bergen
- Department of Orthopedic Surgery, Amphia Hospital Breda, Breda, The Netherlands
| | - L de Girolamo
- Orthopaedic Biotechnology Laboratory, Galeazzi Orthopaedic Institute, Milan, Italy
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Heidar Abady A, Rosedale R, Chesworth BM, Rotondi MA, Overend TJ. Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study. J Man Manip Ther 2017; 25:235-243. [PMID: 29449765 DOI: 10.1080/10669817.2017.1313929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objectives The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment for shoulder complaints. The secondary objective was to describe the frequency of discharge over time by MDT classification. Methods International, MDT-trained study collaborators recruited 93 patients attending physiotherapy for rehabilitation of a shoulder problem. The Numeric Pain Rating Scale (NPRS) and the Upper Extremity Functional Index (UEFI) were collected at the initial assessment and two and four weeks after treatment commenced. A two-way mixed model analysis of variance with planned pairwise comparisons was performed to identify where the differences between MDT classification groups actually existed. Results The Derangement and Spinal classifications had significantly lower NPRS scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The Derangement and Spinal classifications had significantly higher UEFI scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The frequency of discharge at week 2 was 37% for both Derangement and Spinal classifications, with no discharges for the Dysfunction classification at this time point. The frequency of discharge at week 4 was 83, 82 and 15% for the Derangement, Spinal and Dysfunction classifications, respectively. Discussion Classifying patients with shoulder pain using the MDT system can impact treatment outcomes and the frequency of discharge. When MDT-trained clinicians are allowed to match the intervention to a specific MDT classification, the outcome is aligned with the response expectation of the classification.Level of Evidence: 2b.
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Affiliation(s)
| | | | - Bert M Chesworth
- School of Physical Therapy, Western University, London, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Michael A Rotondi
- School of Kinesiology and Health Sciences, York University, Toronto, Canada
| | - Tom J Overend
- School of Physical Therapy, Western University, London, Canada
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50
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Shire AR, Stæhr TAB, Overby JB, Bastholm Dahl M, Sandell Jacobsen J, Høyrup Christiansen D. Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis. BMC Musculoskelet Disord 2017; 18:158. [PMID: 28416022 PMCID: PMC5393017 DOI: 10.1186/s12891-017-1518-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/04/2017] [Indexed: 02/01/2023] Open
Abstract
Background Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome. Methods Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate. Results Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD −0.19 (95% CI −0.61, 0.22) and SMD 0.30 (95% CI −0.16, 0.76) for function. Conclusions There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1518-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison R Shire
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark.
| | - Thor A B Stæhr
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark
| | - Jesper B Overby
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark
| | | | | | - David Høyrup Christiansen
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
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