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Raeesi J, Negahban H, Kachooei AR, Moradi A, Ebrahimzadeh MH, Daghiani M. Comparing the effect of physiotherapy and physiotherapy plus corticosteroid injection on pain intensity, disability, quality of life, and treatment effectiveness in patients with Subacromial Pain Syndrome: a randomized controlled trial. Disabil Rehabil 2023; 45:4218-4226. [PMID: 36398695 DOI: 10.1080/09638288.2022.2146215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the short and medium-term effects of physiotherapy plus corticosteroid injection (combined) with physiotherapy alone on pain intensity, disability, Quality of Life (QoL), and treatment effectiveness in patients with Subacromial Pain Syndrome (SAPS). METHODS In this double-blind, parallel Randomized Controlled Trial (RCT), 50 patients with SAPS were randomly assigned into combined (N = 25, a single injection 3-6 days before physiotherapy) and physiotherapy alone group (N = 25). Pain, disability, QoL, and treatment-effectiveness were measured at pre-intervention, post-intervention, and 3 and 6-month follow-up with Visual Analog Scale (VAS), Shortened Disability of the Arm, Shoulder, and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI) (primary outcome measure), Western Ontario Rotator Cuff (WORC), and Global Rating of Change (GRC) respectively. A 2 × 4 (group × time) mixed model analysis of variance (ANOVA) was applied for analysis. RESULTS The ANOVA revealed statistically significant group-in-time interaction for all outcome measures (p-value < 0.05). The independent t-test showed more effectiveness in the combined group at medium-term, as the mean scores of almost all outcome measures were substantially lesser (p < 0.01). Moreover, in short-time, despite a greater number of patients stating "completely recovered" in the combined group, there was no statistically significant difference between groups. CONCLUSIONS Effects of physiotherapy plus corticosteroid injection could be more long-lasting than physiotherapy alone in improving pain intensity, disability, QoL, and treatment effectiveness in patients with SAPS. TRIAL REGISTRATION NUMBER IRCT20201010048980N1.IMPLICATIONS FOR REHABILITATIONShoulder pain is common, persistent, and predominantly results from subacromial pain syndrome (SAPS).Physiotherapy and corticosteroid injections are effective interventions for this condition.Comprehensive physiotherapy alone can be as effective as corticosteroid injection combined with physiotherapy in the short term.A combined approach versus physiotherapy alone may have more medium-term effects on SAPS patients' pain, disability, quality of life, and treatment effectiveness.
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Affiliation(s)
- Javad Raeesi
- School of Physical Therapy, Health and Rehabilitation Sciences Department, Western University, London, Canada
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Science, Mashhad, Iran
| | - Hossein Negahban
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Science, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Maryam Daghiani
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Science, Mashhad, Iran
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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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Wang S, Zeng J, Chapple CM, Mani R, Ribeiro DC. Initial effect of high-volume mobilisation with movement on shoulder range of motion and pain in patients with rotator cuff-related shoulder pain: protocol for a randomised controlled trial (Evolution Trial). BMJ Open 2023; 13:e069919. [PMID: 37558449 PMCID: PMC10414061 DOI: 10.1136/bmjopen-2022-069919] [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: 11/07/2022] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Mobilisation with movement (MWM) is commonly used for treating patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving shoulder range of motion (ROM) and pain in patients with RCRSP is limited. It is also unclear whether higher volume MWM leads to better clinical outcomes compared with lower volume MWM in patients with RCRSP. The primary aim of this study is to assess the effect of MWM on the angular onset of pain during shoulder abduction in patients with RCRSP. METHODS AND ANALYSIS Sixty participants with RCRSP will be randomised to receive either MWM or sham MWM intervention. The primary outcome is the angular onset of pain during shoulder abduction, and secondary outcomes are pain intensity at the angular onset of pain during shoulder abduction, maximum shoulder ROM, pain intensity during maximum shoulder abduction, pressure pain threshold, mechanical temporal summation, global rating of change scale (GROC) and Brief Pain Inventory-Short Form (BPI-SF). The angular onset of pain and the pain intensity at that range will be assessed at baseline, after 1 set and 3 sets of 10 repetitions of MWM or sham MWM. The GROC will be measured immediately after receiving 3 sets of interventions and on day 3 after interventions. The BPI-SF will be measured on days 1, 3, 5 and 7 after interventions. Other secondary outcomes will be assessed at baseline and after 3 sets of interventions. A linear mixed effects model with a random intercept will be used to compare changes in the outcome measures between MWM and sham MWM interventions. ETHICS AND DISSEMINATION This study has been approved by the University of Otago Ethics Committee (Ref. H21/117). Findings from this study will be disseminated through presentations at international and national conferences and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN 12621001723875.
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Affiliation(s)
- Sizhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Cathy M Chapple
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Wang S, Mani R, Zeng J, Chapple CM, Ribeiro DC. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in patients with rotator cuff-related shoulder pain. Braz J Phys Ther 2023; 27:100535. [PMID: 37633094 PMCID: PMC10474368 DOI: 10.1016/j.bjpt.2023.100535] [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] [Received: 01/25/2023] [Revised: 07/11/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown. OBJECTIVE We examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP. METHODS Seventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC3,1) and minimal detectable change (MDC90). RESULTS The reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC90 for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC90 for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively. CONCLUSION This study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes.
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Affiliation(s)
- Sizhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Jiaxu Zeng
- Department of Preventive and Social Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Cathy M Chapple
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand.
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Signorino JA, Thompson AG, Hando BR, Young JL. Identifying Conservative Interventions for Individuals with Subacromial Pain Syndrome Prior to Undergoing a Subacromial Decompression: A Scoping Review. Int J Sports Phys Ther 2023; 18:293-308. [PMID: 37020452 PMCID: PMC10069387 DOI: 10.26603/001c.73312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background Subacromial decompression (SAD) surgery remains a common treatment for individuals suffering from subacromial pain syndrome (SAPS), despite numerous studies indicating that SAD provides no benefit over conservative care. Surgical protocols typically recommend surgery only after exhausting conservative measures; however, there is no consensus in the published literature detailing what constitutes conservative care "best practice" before undergoing surgery. Purpose To describe conservative interventions received by individuals with SAPS prior to undergoing a SAD. Study Design Scoping review. Methods An electronic search using MEDLINE, CINAHL, PubMed, and Scopus databases was conducted. Peer-reviewed randomized controlled control trials and cohort studies published between January 2000 and February 2022 that included subjects diagnosed with SAPS who progressed to receive a SAD were eligible. Subjects who received previous or concurrent rotator cuff repair with SAPS were excluded. Conservative interventions and treatment details that subjects received prior to undergoing a SAD were extracted. Results Forty-seven studies were included after screening 1,426 studies. Thirty-six studies (76.6%) provided physical therapy (PT) services, and six studies (12.8%) included only a home exercise program. Twelve studies (25.5%) specifically detailed the delivered PT services, and 20 studies (42.6%) stated who provided the PT interventions. Subacromial injections (SI) (55.3%, n=26) and non-steroidal anti-inflammatories (NSAIDs) (31.9%, n=15) were the next most frequently delivered interventions. Thirteen studies (27.7%) included combined PT and SI. The duration of conservative care varied from 1.5 months to 16 months. Conclusion Conservative care that individuals with SAPS receive to prevent advancement to SAD appears inadequate based on the literature. Interventions, such as PT, SI, and NSAIDs, are either underreported or not offered to individuals with SAP prior to advancing to surgery. Many questions regarding optimal conservative management for SAPS persists. Level of Evidence n/a.
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Affiliation(s)
| | | | - Benjamin R Hando
- Division of Physical Therapy Shenandoah University
- DScPT Program Bellin College
- Special Warfare Training Wing
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Ortega-Castillo M, Cuesta-Vargas A, Luque-Teba A, Trinidad-Fernández M. The role of progressive, therapeutic exercise in the management of upper limb tendinopathies: A systematic review and meta-analysis. Musculoskelet Sci Pract 2022; 62:102645. [PMID: 35964498 DOI: 10.1016/j.msksp.2022.102645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/26/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Among upper limb tendinopathies, rotator cuff-related shoulder pain and lateral elbow tendinopathy are the most representative disorders. Therapeutic exercise arises as an effective approach, but there is no consensus about the optimal progression criteria. OBJECTIVE To compare progression criteria and effectiveness of isolated, progressive exercises in the management of upper limb tendinopathies. Additionally, to perform a meta-analysis of pain/function for the selected programs. DESIGN Systematic Review and Meta-Analysis. METHOD Database search of randomized-controlled-trials including progressive exercise was conducted in PubMed and Scopus until October 2020. Meta-analysis' inclusion criteria were: no data duplicity; 3-months follow-up; comparison between any type of progressive exercise program. Risk of bias was assessed with PEDro score, and level of evidence followed GRADE guidelines. Effect size was calculated with Cohen's d. RESULTS Eleven studies were included. GRADE revealed low-quality evidence for meta-analysis of pain during activity (d = 0.29) and function (d = 0.33) at 3 months. Progression criteria were categorised into two divisions, being pain the central concept. Pain (rest/activity/night) and function improved significantly within-group, but between-group changes were heterogeneous. Meta-analysis regarding pain showed good homogeneity with significant, moderate effects (I2 = 20%; p = 0.005; mean d = 0.29); function yielded important heterogeneity with non-significant, moderate effects (I2 = 81%; p = 0.17; mean d = 0.33). CONCLUSIONS Pain was the most frequent benchmark when modulating and progressing the exercises, although other criteria were found such as fatigue or self-perceived ability. Progressive exercise seems effective to manage upper limb tendinopathies, but the superiority of a progression criterion against others remains unclear. Low-quality evidence supported progressive exercise with eccentric components in adding a significant and moderate effect on pain/function at short-term.
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Affiliation(s)
- Miguel Ortega-Castillo
- Department of Physiotherapy, Clinimetric Group F-14, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, 29010, Málaga, Spain.
| | - Antonio Cuesta-Vargas
- Department of Physiotherapy, Clinimetric Group F-14, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, 29010, Málaga, Spain; School of Clinical Science, Queensland University Technology, Brisbane, 4072, Australia. https://twitter.com/aicuesta
| | - Antonio Luque-Teba
- Higher Technical School of Informatics Engineering, University of Sevilla, 41092, Sevilla, Spain.
| | - Manuel Trinidad-Fernández
- Department of Physiotherapy, Clinimetric Group F-14, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, 29010, Málaga, Spain; Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, 1090, Brussel, Belgium.
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Effects of Ultrasound-Guided Injection Combined with a Targeted Therapeutic Exercise in Breast Cancer Women with Subacromial Pain Syndrome: A Randomized Clinical Study. J Pers Med 2022; 12:jpm12111833. [PMID: 36579554 PMCID: PMC9697338 DOI: 10.3390/jpm12111833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/01/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
In this randomized controlled study, we aimed to assess the effects of US-guided injections of the subacromial bursa followed by a personalized rehabilitation program for breast cancer (BC) survivors. We assessed patients with subacromial pain syndrome without tendon lesions and with a history of post-surgical non-metastatic BC. Thirty-seven patients were enrolled and randomly assigned 1:1 to receive US-guided corticosteroid injections combined with a personalized rehabilitation program (Group A; n: 19) or US-guided corticosteroid injections alone (Group B; n: 18). The primary outcome was pain relief, assessed using a numerical pain rating scale (NPRS). The secondary outcomes were muscle strength, shoulder function, and quality of life. No major or minor late effects were reported after the multidisciplinary intervention. Statistically significant within-group differences were found in terms of NPRS (p ≤ 0.05) in both groups. No significant between-group differences were reported after one week. However, the between-group analysis showed significant differences (p ≤ 0.05) after three months of follow-up in terms of pain intensity, muscle strength, shoulder function, and quality of life. Our findings suggested positive effects of a multidisciplinary approach including US-guided corticosteroid injections combined with a personalized rehabilitation program in improving pain intensity and quality of life of BC survivors with subacromial pain syndrome.
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Buchbinder R, Karjalainen TV, Gorelik A. Editorial Commentary: Arthroscopic Treatment Should No Longer Be Offered to People With Subacromial Impingement. Arthroscopy 2022; 38:2525-2528. [PMID: 35940744 DOI: 10.1016/j.arthro.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
Arthroscopic treatment should no longer be offered to people with subacromial impingement. In many people, subacromial impingement (or subacromial pain syndrome) is self-limiting and may not require any specific treatment. This is evident by the fact that almost 50% of people with new-onset shoulder pain consult their primary care doctor only once. The best-available evidence from randomized controlled trials indicates that glucocorticoid injection provides rapid, modest, short-term pain relief. Exercise therapy has also been found to provide no added benefit over glucocorticoid injection. Subacromial decompression (bursectomy and acromioplasty) for subacromial pain syndrome provides no important benefit on pain, function, or health-related quality of life. Acromioplasty does not improve the outcomes of rotator cuff repair.
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Lavoie-Gagne O, Farah G, Lu Y, Mehta N, Parvaresh KC, Forsythe B. Physical Therapy Combined With Subacromial Cortisone Injection Is a First-Line Treatment Whereas Acromioplasty With Physical Therapy Is Best if Nonoperative Interventions Fail for the Management of Subacromial Impingement: A Systematic Review and Network Meta-Analysis. Arthroscopy 2022; 38:2511-2524. [PMID: 35189304 DOI: 10.1016/j.arthro.2022.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To construct an algorithm to optimize clinical outcomes in subacromial impingement based on current, high-level evidence. METHODS A systematic review of all clinical trials on subacromial impingement published from 1999 to 2020 was performed. Demographic, clinical, range of motion (ROM), and patient-reported outcome measure (PROM) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model and treatments ranked via surface under the cumulative ranking curves with respect to 3 domains: pain, PROMs, and ROM. RESULTS A total of 35 studies comprising 3,643 shoulders (42% female, age 50 ± 5 years) were included. Arthroscopic decompression with acromioplasty ranked much greater than arthroscopic decompression alone for pain relief and PROM improvement, but the difference in absolute PROMs was not statistically significant. Corticosteroid injection (CSI) alone demonstrated inferior outcomes across all 3 domains (pain, PROMs, and ROM) with low cumulative rankings. Physical therapy (PT) with CSI demonstrated moderate-to-excellent clinical improvement across all 3 domains whereas PT alone demonstrated excellent ROM and low-moderate outcomes in pain and PROM domains. PT with nonsteroidal anti-inflammatory drugs or alternative therapies ranked highly for PROM outcomes and moderate for pain and ROM domains. Finally, platelet-rich plasma injections demonstrated moderate outcomes for pain, forward flexion, and abduction with very low-ranking outcomes for PROMs and external rotation. CONCLUSIONS Arthroscopic decompression with acromioplasty and PT demonstrated superior outcomes whereas CSI demonstrated poor outcomes in all 3 domains (pain, PROMs, and ROM). For patients with significant symptoms, the authors recommend PT with CSI as a first-line treatment, followed by acromioplasty and PT if conservative treatment fails. For patients with symptoms limited to 1 to 2 domains, the authors recommend a shared decision-making approach focusing on treatment rankings within domains pertinent to individual patient symptomatology. LEVEL OF EVIDENCE I, systematic review and network meta-analysis of Level I studies.
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Affiliation(s)
- Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Ghassan Farah
- Department of Orthopaedics, University of California San Diego, San Diego, California, U.S.A
| | - Yining Lu
- Department of Orthopaedics, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Nabil Mehta
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kevin C Parvaresh
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Wang S, Chapple CM, Quinn D, Tumilty S, Ribeiro DC. Dosage of joint mobilisation for the management of rotator cuff-related shoulder pain: protocol for a scoping review. BMJ Open 2022; 12:e056771. [PMID: 36691247 PMCID: PMC9171208 DOI: 10.1136/bmjopen-2021-056771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/09/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive. OBJECTIVES To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage. METHODS AND ANALYSIS We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis. ETHICS AND DISSEMINATION Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.
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Affiliation(s)
- Sizhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Cathy M Chapple
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
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11
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Bourke J, Skouteris H, Hatzikiriakidis K, Fahey D, Malliaras P. Use of Behavior Change Techniques Alongside Exercise in the Management of Rotator Cuff-Related Shoulder Pain: A Scoping Review. Phys Ther 2022; 102:6482025. [PMID: 34972867 DOI: 10.1093/ptj/pzab290] [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] [Received: 01/20/2021] [Revised: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The aims of this scoping review were to: (1) determine the frequency and types of behavior change techniques (BCTs) and education utilized in trials investigating exercise interventions for rotator cuff related shoulder pain (RCRSP); (2) subcategorize the BCTs and education found in the trials to summarize all behavior change approaches reported by trials; and (3) compare the frequency, types, and subcategories of BCTs and education utilized in the clinical guidelines for managing RCRSP between the trials. METHODS Data sources included Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, Google Scholar and PubMed, which were searched from inception to June 2020. Trials assessing exercise interventions for RCRSP were included. Three authors independently determined eligibility and extracted data. The frequency and types of BCTs and education in the trials and clinical practice guidelines were reported and compared descriptively. Two authors assessed the content of the BCTs to develop subcategories. RESULTS Most trials reported including at least 1 type of BCT (89.2%), which was most commonly feedback and monitoring (78.5%). There were many different approaches to the BCTs and education; for example, feedback and monitoring was subcategorized into supervised exercise, exercise monitoring, and feedback through external aids, such as mirrors. Clinical guidelines recommend supervision, goal setting, activity modification, pain management recommendations, information about the condition, and exercise education. CONCLUSION Although over two-thirds of trials reported including a BCT alongside exercise interventions for RCRSP, the breadth of these interventions is limited (supervision is the only common one). Future trialists should consider using any type of BCT that may improve exercise adherence and outcomes. IMPACT The findings of this review have: (1) identified gaps in the literature; and (2) contributed to the design of future exercise interventions for RCRSP.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kostas Hatzikiriakidis
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Fahey
- Enhance Sports Performance and Rehabilitation, Maribyrnong, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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12
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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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13
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Malliaras P, Johnston R, Street G, Littlewood C, Bennell K, Haines T, Buchbinder R. The Efficacy of Higher Versus Lower Dose Exercise in Rotator Cuff Tendinopathy: A Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil 2020; 101:1822-1834. [DOI: 10.1016/j.apmr.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 01/29/2023]
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14
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Azadvari M, Emami-Razavi SZ, Torfi F, Nazar NSB, Malekirad AA. Ultrasound-guided versus blind subacromial bursa corticosteroid injection for paraplegic spinal cord injury patients with rotator cuff tendinopathy: a randomized, single-blind clinical trial. Int J Neurosci 2020; 131:445-452. [PMID: 32354299 DOI: 10.1080/00207454.2020.1748620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Shoulder pain is one of the common musculoskeletal complaints of the patients with spinal cord injury. Corticosteroid injection to the subacromial bursa is one of the confirmed therapies which can be guided by anatomic landmarks or ultrasound. This study is aimed to compare these two methods to find the one with the highest therapeutic impact. MATERIALS AND METHODS In this study, 30 patients with paraplegic SCI suffering from shoulder pain were enrolled. They were divided into 2 groups based on 4-block randomization sampling. The first group received subacromial corticosteroid injection through anatomic landmarks; while in the second group, the injection was guided by ultrasound. VAS criterion was employed for investigation of pain severity; while the constant score was used to study the shoulder pain and function. BREF questionnaire was also applied to examine the quality of life. FINDINGS The mean scores of VAS and Constant in both groups showed a significant improvement two months after intervention when compared with their condition before the intervention. This improvement was significantly higher in the ultrasound group. The physical, physiological and environmental health scores of BREF questionnaire as well as their total score showed a significant improvement in both groups two months after intervention. But this improvement was not significantly different between the two groups in terms of any of the items. DISCUSSION Hence, although ultrasound-guided injection is more costly and requires higher skills in comparison with blind injection, it is significantly more effective in controlling the pain and improving the shoulder function.
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Affiliation(s)
- Mohaddeseh Azadvari
- Physical Medicine and Rehabilitation Department, Imam Khomeini and Sina Hospitals, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami-Razavi
- Physical Medicine and Rehabilitation Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Torfi
- Resident of General Surgery, Surgical Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Najmeh Sadat Boland Nazar
- Physical Medicine and Rehabilitation Department, Medical and Educational Center of Taleghani Hospital,Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Ali Akbar Malekirad
- Department of Psychology, Payame Noor University, Tehran, Iran.,Toxicology and Diseases Group, the Institute of Pharmaceutical Sciences (TIPS), and Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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15
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Kulakli F, Ilhanli I, Sari IF, Türköz A, Çelik C. Can the efficacy of subacromial corticosteroid injection be improved using a single- session mobilization treatment in subacromial impingement syndrome? A randomized single-blind controlled trial. Turk J Med Sci 2020; 50:205-212. [PMID: 31865665 PMCID: PMC7080397 DOI: 10.3906/sag-1909-51] [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] [Received: 09/11/2019] [Accepted: 12/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background/aim The objective in this study is to assess the short-term effects of a single-session mobilization in addition to subacromial corticosteroid (SACS) injection in impingement syndrome. Materials and methods The study was designed as a prospective randomized controlled single-blind, parallel group clinical trial. Patients (totally 84) were divided randomly into two groups equally. Forty-two patients in Group 1 received mobilization and SACS injection, whereas 42 patients in Group 2 only received SACS injections. A single SACS injection was applied in all patients. Mobilization was administered as a single session right after SACS injection. Patients’ evaluations were performed measuring active range of motion (AROM), visual analogue scale (VAS) during activity and rest, and Disabilities of Arm, Shoulder, and Hand Score (DASH) prior to treatment and in the first and fourth weeks following the treatment. Results Both groups showed significant improvement in terms of AROM, VAS, and DASH scores in each evaluation step (P < 0.05). Visual analogue scale activity in the first week was significantly better in Group 1 (P = 0.028). Also, flexion and abduction degrees showed significantly better outcomes in Group 1 (P = 0.007, P = 0.036). Conclusion Addition of single-session mobilization might provide rapid improvement in flexion and abduction as well as early pain relief following SACS injections.
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Affiliation(s)
- Fazil Kulakli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ilker Ilhanli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ilker Fatih Sari
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Adem Türköz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Canan Çelik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Giresun, Turkey
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16
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Riel H, Vicenzino B, Olesen JL, Jensen MB, Ehlers LH, Rathleff MS. Corticosteroid injection plus exercise versus exercise, beyond advice and a heel cup for patients with plantar fasciopathy: protocol for a randomised clinical superiority trial (the FIX-Heel trial). Trials 2020; 21:5. [PMID: 31898517 PMCID: PMC6941397 DOI: 10.1186/s13063-019-3977-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background Plantar fasciopathy has a lifetime prevalence of 10%. Patients experience sharp pain under the heel, often for several months or years. Multiple treatments are available, but no single treatment appears superior to the others. A corticosteroid injection offers short-term pain relief but is no better than placebo in the longer term (> 8 weeks). Heavy-slow resistance training has shown potentially positive effects on long-term outcomes (> 3 months), and combining exercises with an injection may prove to be superior to exercises alone. However, the effect of heavy-slow resistance training compared with a simpler approach of patient advice (e.g., load management) and insoles is currently unknown. This trial compares the efficacy of patient advice with patient advice plus heavy-slow resistance training and with patient advice plus heavy-slow resistance training plus a corticosteroid injection in improving the Foot Health Status Questionnaire pain score after 12 weeks in patients with plantar fasciopathy. Methods In this randomised superiority trial, we will recruit 180 patients with ultrasound-confirmed plantar fasciopathy and randomly allocate them to one of three groups: (1) patient advice and an insole (n = 60); (2) patient advice, an insole, and self-dosed heavy-slow resistance training consisting of heel raises (n = 60); or (3) patient advice, an insole, heavy-slow resistance training, and an ultrasound-guided corticosteroid injection (n = 60). All participants will be followed for 1 year, with the 12-week follow-up considered the primary endpoint. The primary outcome is the Foot Health Status questionnaire pain domain score. Secondary outcomes include the remaining three domains of the Foot Health Status Questionnaire, a 7-point Global Rating of Change, the Pain Self-Efficacy Questionnaire, physical activity level, health-related quality of life measured by the EQ-5D-5L, and Patient Acceptable Symptom State, which is the point at which participants feel no further need for treatment. Additionally, a health economic evaluation of the treatments will be carried out. Discussion This trial will test if adding heavy-slow resistance training to fundamental patient advice and an insole improves outcomes and if a corticosteroid injection adds even further to that effect in patients with plantar fasciopathy. Trial registration ClinicalTrials.gov, NCT03804008. Prospectively registered on January 15, 2019.
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Affiliation(s)
- Henrik Riel
- Center for General Practice at Aalborg University, Fyrkildevej 7, 9220, Aalborg East, Denmark.
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia, QLD, 4072, Australia
| | - Jens Lykkegaard Olesen
- Center for General Practice at Aalborg University, Fyrkildevej 7, 9220, Aalborg East, Denmark
| | - Martin Bach Jensen
- Center for General Practice at Aalborg University, Fyrkildevej 7, 9220, Aalborg East, Denmark
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements (DCHI), Department of Business and Management, The Faculty of Social Sciences, Aalborg University, Fibigerstræde 11, 9220, Aalborg East, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Fyrkildevej 7, 9220, Aalborg East, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, 9220, Aalborg East, Denmark.,Department of occupational therapy and physiotherapy, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
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17
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Walker T, Salt E, Lynch G, Littlewood C. Screening of the cervical spine in subacromial shoulder pain: A systematic review. Shoulder Elbow 2019; 11:305-315. [PMID: 31316592 PMCID: PMC6620799 DOI: 10.1177/1758573218798023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/09/2018] [Accepted: 07/07/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain. Currently, there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain, which risks patients receiving misguided and/or ineffective interventions. OBJECTIVE To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain. DESIGN Systematic review of randomized controlled trials. METHODS Electronic searches of PEDro and MEDLINE to December 2016 were conducted. Randomized controlled trials evaluating the effectiveness of interventions within the current scope of physiotherapy comprising of adult patients complaining of subacromial shoulder pain were included. Data relating to the method of cervical spine screening were extracted and synthesized categorically. RESULTS One hundred and two studies were included. Twenty-six (25.5%) were categorized as "No method of screening undertaken or reported," 49 (48.0%) were categorized as "Localized cervical spine symptoms and/or radiculopathy/radicular pain," nine (8.8%) were categorized as "Cervical examination," two (2.0%) were categorized as "Manual testing," two (2.0%) were categorized as "History of cervical surgery," and 14 (13.7%) were categorized as using "Combined approaches." CONCLUSION Examination of the cervical spine in patients with subacromial shoulder pain is variable in randomized controlled trials. In many instances, no or minimal attempts to screen were undertaken or reported. This has potential research and management implications and further research is indicated to facilitate development of this aspect of examination.
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Affiliation(s)
- Tom Walker
- Connect Health, Musculoskeletal Service, Dewsbury Health Centre, Dewsbury, UK,Tom Walker, Connect Health, Musculoskeletal Service, Dewsbury Health Centre, Wellington Road, Dewsbury WF13 1HN, UK.
| | - Emma Salt
- Burton Hospitals NHS Foundation Trust, Queen’s Hospital, Burton-on-Trent, UK
| | - Greg Lynch
- Inform Physiotherapy Limited, Silverstream, New Zealand
| | - Chris Littlewood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, UK
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18
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Ogbeivor C. Needle placement approach to subacromial injection in patients with subacromial impingement syndrome: A systematic review. Musculoskeletal Care 2019; 17:13-22. [PMID: 30623595 DOI: 10.1002/msc.1375] [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] [Received: 10/15/2018] [Revised: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Subacromial impingement syndrome (SAIS) is the most common cause of shoulder pain and is costly, in terms of disability and health service provision. Research evidence suggests that, generally, the anterior, lateral and posterior approaches are used by clinicians for subacromial injection. However, it is uncertain which of these approaches is more effective than the other in the management of SAIS. OBJECTIVES The aim of the present study was to determine the effectiveness of the anterior, lateral approach to subacromial injection compared with the posterior approach for the treatment of SAIS. METHODS A comprehensive search was undertaken of CINAHL, MEDLINE, Cochrane, PEDro and the E-Journals databases using full texts, from 1980 to April 2014 and updated in December 2016 via the Chartered Society of Physiotherapy (EBSCOhost). Studies of SAIS patients receiving cortisone injections which investigated needle placement through the lateral, posterior or anterior routes were included. Study selection, data extraction and appraisal of the study were undertaken by the researcher and his supervisor. Quality criteria were selected from PEDro, to form a checklist of 10 items. RESULTS A total of 4265 citations were retrieved and screened for eligibility; 39 articles were assessed as full text and 8 met the inclusion criteria. They include four randomized controlled trials and four controlled trials. Due to the varying methodological quality, and clinical and statistical heterogeneity of these studies, they were analysed qualitatively, as a meta-analysis was not possible. CONCLUSIONS The evidence establishing the superiority of any one method of subacromial injection approach over the other is unclear in clinical practice. This calls for further research into this area.
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Affiliation(s)
- Collins Ogbeivor
- Rehabilitation Department, John Hopkins Healthcare Aramco, Dhahran, Kingdom of Saudi Arabia
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19
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van der Windt DA, Burke DL, Babatunde O, Hattle M, McRobert C, Littlewood C, Wynne-Jones G, Chesterton L, van der Heijden GJMG, Winters JC, Rhon DI, Bennell K, Roddy E, Heneghan C, Beard D, Rees JL, Riley RD. Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis. Diagn Progn Res 2019; 3:15. [PMID: 31410370 PMCID: PMC6686538 DOI: 10.1186/s41512-019-0061-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shoulder pain is one of the most common presentations of musculoskeletal pain with a 1-month population prevalence of between 7 and 26%. The overall prognosis of shoulder pain is highly variable with 40% of patients reporting persistent pain 1 year after consulting their primary care clinician. Despite evidence for prognostic value of a range of patient and disease characteristics, it is not clear whether these factors also predict (moderate) the effect of specific treatments (such as corticosteroid injection, exercise, or surgery). OBJECTIVES This study aims to identify predictors of treatment effect (i.e. treatment moderators or effect modifiers) by investigating the association between a number of pre-defined individual-level factors and the effects of commonly used treatments on shoulder pain and disability outcomes. METHODS This will be a meta-analysis using individual participant data (IPD). Eligible trials investigating the effectiveness of advice and analgesics, corticosteroid injection, physiotherapy-led exercise, psychological interventions, and/or surgical treatment in patients with shoulder conditions will be identified from systematic reviews and an updated systematic search for trials, and risk of bias will be assessed. Authors of all eligible trials will be approached for data sharing. Outcomes measured will be shoulder pain and disability, and our previous work has identified candidate predictors. The main analysis will be conducted using hierarchical one-stage IPD meta-analysis models, examining the effect of treatment-predictor interaction on outcome for each of the candidate predictors and describing relevant subgroup effects where significant interaction effects are detected. Random effects will be used to account for clustering and heterogeneity. Sensitivity analyses will be based on (i) exclusion of trials at high risk of bias, (ii) use of restricted cubic splines to model potential non-linear associations for candidate predictors measured on a continuous scale, and (iii) the use of a two-stage IPD meta-analysis framework. DISCUSSION Our study will collate, appraise, and synthesise IPD from multiple studies to examine potential predictors of treatment effect in order to assess the potential for better and more efficient targeting of specific treatments for individuals with shoulder pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018088298.
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Affiliation(s)
- Danielle A. van der Windt
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Danielle L. Burke
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Opeyemi Babatunde
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Miriam Hattle
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Cliona McRobert
- 0000 0004 1936 8470grid.10025.36School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Chris Littlewood
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Gwenllian Wynne-Jones
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Linda Chesterton
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Geert J. M. G. van der Heijden
- 0000000084992262grid.7177.6Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan C. Winters
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Daniel I. Rhon
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX USA
| | - Kim Bennell
- 0000 0001 2179 088Xgrid.1008.9Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Edward Roddy
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, UK
| | - Carl Heneghan
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care and Health Science, University of Oxford, Oxford, UK
| | - David Beard
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jonathan L. Rees
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Richard D. Riley
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
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20
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Martin SD, Conaway WK, Lei P. Use of Intra-Articular Corticosteroids in Orthopaedics. J Bone Joint Surg Am 2018; 100:885-891. [PMID: 29762289 DOI: 10.2106/jbjs.17.00289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Scott D Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - William K Conaway
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Pengfei Lei
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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