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Conte da Silva A, Nazário AK, Aily JB, Mattiello SM. Treatment of upper trapezius myofascial trigger points does not influence pain in individuals with shoulder pain: A randomized trial. J Bodyw Mov Ther 2025; 42:71-77. [PMID: 40325744 DOI: 10.1016/j.jbmt.2024.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 10/26/2024] [Accepted: 11/16/2024] [Indexed: 05/07/2025]
Abstract
OBJECTIVE Assess whether manual therapy combined with the ischemic compression (IC) technique on myofascial trigger points (MTrPs) in the upper trapezius has the potential to affect shoulder pain and the quantity of MTrPs in the middle and lower trapezius muscles in individuals experiencing shoulder pain. METHODS Sixty individuals with shoulder pain were randomly assigned to three groups: Mobilization Group (MG, n = 20), underwent joint mobilizations of the shoulder complex; Compression Group (CG, n = 20), received mobilizations combined with IC on the myofascial trigger points (MTrPs) in the upper trapezius; and Placebo Group (PG, n = 20), underwent mobilizations combined with placebo IC. The interventions were administered twice a week for a duration of six weeks. Assessments were conducted at three time points: pre-treatment (week-0), post-treatment (week-6), and after a 1-month follow-up (week-10). Pain levels were evaluated using the Visual Analogue Scale and the number of MTrPs was counted by manual palpation for each muscle portion. RESULTS Assessments in week 6 showed decreased pain for all groups (p < 0.05). Moreover, the number of MTrPs of the upper trapezius decreased in the CG and MG (p = 0.05); for the middle trapezius decreases were observed only in the MG and for the lower trapezius decreases only in the CG. At week 10, all groups maintained the post-intervention effects, without differences between groups. CONCLUSION The addition of the IC technique on the upper trapezius MTrPs was able to influence the number of MTrPs of the three portions of the trapezius muscle. The pain decreased in all individuals.
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Affiliation(s)
- Alyssa Conte da Silva
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.
| | - Ana Karoline Nazário
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Jéssica Bianca Aily
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Stela Marcia Mattiello
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
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Manoso-Hernando D, Elizagaray-García I, Bailón-Cerezo J, Struyf F, Gil-Martínez A. Pain localization and associations with strength and range of motion deficits in rotator cuff-related shoulder pain vs asymptomatic: A cross sectional case control study. Musculoskelet Sci Pract 2025; 78:103354. [PMID: 40398072 DOI: 10.1016/j.msksp.2025.103354] [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] [Received: 12/05/2024] [Revised: 05/08/2025] [Accepted: 05/09/2025] [Indexed: 05/23/2025]
Abstract
BACKGROUND Methods previously proposed to assess patients with rotator cuff related shoulder pain (RCRSP), based on special orthopedic tests, have been challenged. This opens the possibility of a different physical examination where shoulder range of motion (ROM), muscle strength, pain mapping and the examination of the muscle trigger points (TrPs) seem to be an accepted method. OBJECTIVES To compare the biomechanical and functional characteristics of the shoulder complex in individuals with RCRSP and asymptomatic controls. DESIGN A cross-sectional study. METHODS Thirty six RCRSP patients and 36 asymptomatic subjects matched by sex, age and hand dominance. Assessed variables included shoulder strength and ROM, pain mapping and the presence of muscle TrPs. Independent t-tests were used to compare each of these measurements and multiple linear regression was used to examine the capacity of shoulder strength variables to predict the variability of the shoulder ROM. RESULTS The RCRSP group had significantly reduced shoulder ROM and strength, as well as significantly more active TrPs in the anterior, posterior and infraspinatus muscles than asymptomatic controls. The RCRSP group predominantly referred their pain in the anterior and lateral deltoid area. Main predictors for diminished shoulder flexion and scaption ROM were strength deficits in shoulder external and internal rotation at 90° of shoulder abduction, respectively. CONCLUSION Shoulder ROM, strength and the presence of active TrPs were significantly different between RCRSP patients and asymptomatic controls. RCRSP patients predominantly referred their pain in the anterior and posterior deltoid area.
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Affiliation(s)
- Daniel Manoso-Hernando
- Universidad Autonoma de Madrid, Madrid, Spain; CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Ignacio Elizagaray-García
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Javier Bailón-Cerezo
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
| | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), Madrid, Spain.
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McKenna L, Lowry T, Beales D. Increased central sensitivity is associated with greater shoulder disability in people with musculoskeletal shoulder symptoms: a cross-sectional study. Musculoskelet Sci Pract 2025; 78:103334. [PMID: 40306013 DOI: 10.1016/j.msksp.2025.103334] [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] [Received: 01/08/2025] [Revised: 04/04/2025] [Accepted: 04/20/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND To fully comprehend shoulder pain and disability, a better understanding of the factors that may contribute to chronicity is required, i.e., increased central sensitivity. OBJECTIVE To determine the association between increased central sensitivity and shoulder disability whilst accounting for confounding factors. To determine the prevalence of increased central sensitivity in those with musculoskeletal shoulder symptoms. DESIGN Cross sectional design collecting data via an online survey. Participants with shoulder symptoms were recruited via social media and through flyer advertisement in Australia. METHODS The Central Sensitivity Inventory and Shoulder Pain and Disability Index were used. Confounding factors included sex, age, socioeconomic status, obesity, psychological distress, sleep quality, physical activity, smoking, ethnicity, and the symptoms of neuropathic pain. The association between increased central sensitivity and shoulder disability was assessed by linear regression whilst adjusting for confounding factors. The percentage of participants with increased central sensitivity was calculated. RESULTS In 249 participants with shoulder symptoms, increased central sensitivity was positively associated with greater shoulder disability, either as a categorical (coefficient 5.5, 95 % CI 0.1-11.0, p 0.046) or continuous variable (coefficient 0.2, 95 % CI 0.03-0.50, p 0.025) whilst adjusting for confounding factors. In the sample, 48.2 % of survey respondents met the threshold for having increased central sensitivity. CONCLUSION Increased central sensitivity was positively associated with greater disability even when accounting for multiple confounders in participants with musculoskeletal shoulder symptoms. These findings highlight the importance of considering increased central sensitivity in the clinical management of those with shoulder symptoms.
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Affiliation(s)
- Leanda McKenna
- Curtin University, Kent St, Bentley, Western Australia, 6102, Australia.
| | - Tamara Lowry
- Curtin University, Kent St, Bentley, Western Australia, 6102, Australia.
| | - Darren Beales
- Curtin University, Kent St, Bentley, Western Australia, 6102, Australia.
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Alaca N, Arslan DÇ, Sırlan S, Yarar HA, Başcı O. Tactile acuity, left/right judgment performance, motor imagery ability, and pressure-pain threshold in patients with chronic rotator cuff-related shoulder pain: a cross-sectional case-control study. Musculoskelet Sci Pract 2025; 76:103278. [PMID: 39929090 DOI: 10.1016/j.msksp.2025.103278] [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: 08/14/2024] [Revised: 12/17/2024] [Accepted: 02/04/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND Chronic pain can alter cortical pain representation, and tests like Two-Point Discrimination Test (TPDT), Left/Right Judgment Task (LRJT), motor imagery, and Pressure-Pain Threshold (PPT) can assess these changes. However, their applicability to all pain mechanisms is uncertain. OBJECTIVE To compare the TPDT, LRJT, motor imagery ability, and PPT of chronic rotator cuff-related shoulder pain (C-RCRSP) patients with asymptomatic and pain-free controls. METHODS Forty-eight C-RCRSP patients and 45 pain-free controls were assessed using a caliper for TPDT and the Recognize® application for LRJT. Motor ability, PPT, physical function, fear avoidance, pain catastrophizing, and Central Sensitization Inventory (CSI) were also evaluated. As part of the subgroup analysis, C-RCRSP patients were divided into two groups based on their CSI (≥40, n = 19; <40, n = 29). RESULTS C-RCRSP patients demonstrated higher TPDT thresholds [acromion (F = 5.41, p = 0.001) and deltoid (F = 26.67, p < 0.001)] but no significant differences in LRJT performance [recognition accuracy (F = 2.47, p = 0.063) and response time (F = 0.98, p = 0.414)] than pain-free controls in both shoulder joints. C-RCRSP patients had poorer motor imagery abilities (p < 0.001). The deltoid region PPT differed significantly between the groups (F = 17.45, p < 0.001), but it was not significant for the tibialis anterior region (F = 1.16, p = 0.33). C-RCRSP patients with a CSI≥40 reported higher night pain, reduced shoulder range of motion, slower response times, poorer motor imagery ability, and higher scores on pain-related questionnaires compared to those with a CSI<40 (p = 0.043-<0.001). CONCLUSION C-RCRSP patients demonstrated poorer tactile acuity, mechanical sensitivity, and motor imagery ability especially in those with central sensitization, which should be considered in treatment planning.
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Affiliation(s)
- Nuray Alaca
- Acıbadem Mehmet Ali Aydınlar University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey; Acıbadem Mehmet Ali Aydınlar University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Dilek Çağrı Arslan
- Acıbadem Mehmet Ali Aydınlar University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey; Bezmialem Vakif University, Institute of Health Sciences, Department of Cardiopulmonary Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Seda Sırlan
- Acıbadem Mehmet Ali Aydınlar University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Hacı Ahmet Yarar
- Dokuz Eylül University, Faculty of Physical Therapy and Rehabilitation, Department of Orthopedic Physiotherapy, Izmir, Turkey.
| | - Onur Başcı
- Dokuz Eylül University Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey.
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Pavlou K, Constantinou A, Savva C, Pamboris GM, Kyriakou P, Ploutarchou G, Karagiannis C, Korakakis V. Absolute and relative reliability of Pressure Pain Threshold (PPT) assessment in patients with nonspecific shoulder pain. Shoulder Elbow 2025:17585732251319739. [PMID: 40026778 PMCID: PMC11866336 DOI: 10.1177/17585732251319739] [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] [Received: 11/05/2024] [Revised: 01/03/2025] [Accepted: 01/24/2025] [Indexed: 03/05/2025]
Abstract
This study investigates the intra- and interrater reliability of Pressure Pain Threshold assessments in patients with nonspecific shoulder pain, focusing on chronic and subacute stages. A sample of 26 adults was evaluated using a mechanical algometer across six anatomical points. Intrarater and interrater reliability were calculated using the intraclass correlation coefficient (ICC), standard error of measurement, and minimal detectable change (MDC). Results demonstrated almost perfect reliability for both intrarater (ICC range: 0.96-0.99) and interrater (ICC range: 0.92-0.99) assessments. Standard error of measurement and MDC values for intrarater reliability showed clinically acceptable error, except for the upper trapezius and mid-deltoid, where MDC value exceeded 25% of the grand mean, suggesting reduced precision between nonspecific shoulder pain stages. For interrater reliability, the adductor pollicis brevis, upper trapezius, and infraspinatus also showed less precision, with MDC values exceeding 25% of the grand mean, particularly in chronic patients. Despite these findings, no significant differences were observed between the subacute and chronic groups. While relative reliability was high, the findings highlight the need for caution in interpreting absolute reliability, especially for inter-rater assessments at specific muscle sites.
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Affiliation(s)
- Kyriakos Pavlou
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - Christos Savva
- Department of Health Sciences, Frederick University, Limassol, Cyprus
| | - George M. Pamboris
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - George Ploutarchou
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
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Requejo-Salinas N, Fernández-Matías R, Gordo Herrera J, Conesa López P, La Touche R, Lluch-Girbés E. Differences in cervical mobility and pain sensitivity between patients with rotator cuff-related shoulder pain and asymptomatic subjects: a cross-sectional study. Arch Physiother 2025; 15:97-109. [PMID: 40356876 PMCID: PMC12067951 DOI: 10.33393/aop.2025.3256] [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: 08/22/2024] [Accepted: 03/24/2025] [Indexed: 05/15/2025] Open
Abstract
Introduction The cervical spine's role in shoulder pain remains unclear, particularly regarding its influence on shoulder pain severity and functional limitations. This study aimed to compare neck mobility, pain sensitivity, and strength between patients with rotator cuff-related shoulder pain (RCRSP) and asymptomatic controls and to explore associations between neck active range of motion (AROM) and shoulder outcomes. Methods A cross-sectional study was conducted with 50 patients with RCRSP and 50 asymptomatic controls. Neck AROM was measured with a CROM device, pressure pain thresholds (PPTs) with a digital algometer, and isometric neck strength with a handheld dynamometer. Shoulder pain and disability were assessed using the Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI). Results Compared to controls, patients with RCRSP exhibited reduced neck rotation toward the affected shoulder (mean difference: -5.19°; 95% CI: -8.84 to -1.38) and lower PPTs bilaterally (affected side: -1.49 kg/cm²; 95% CI: -1.99 to -1.00; unaffected side: -1.42 kg/cm²; 95% CI: -1.98 to -0.91). No differences were found in neck strength. Regression analysis showed that greater neck flexion, lateral flexion toward the affected side, and reduced protraction were associated with higher SPADI scores. Additionally, neck lateral flexion and rotation toward the affected side were negatively associated with shoulder pain intensity over the last week. Conclusion These findings suggest a potential interaction between the cervical spine and shoulder in RCRSP, underscoring the importance of a comprehensive assessment of both cervical and shoulder impairments in this condition.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid - Spain
- International Doctoral School, Rey Juan Carlos University, Alcorcón - Spain
| | | | - Javier Gordo Herrera
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid - Spain
| | - Pablo Conesa López
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid - Spain
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid - Spain
- Neuroscience and Craniofacial Pain Institute (INDCRAN), Madrid - Spain
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Valencian - Spain
- Pain in Motion Research Group, University of Valencia - Spain
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Brown J, Kearns G, Hedges E, Samaniego S, Wang-Price S. Blood Flow of the Infraspinatus Muscle in Individuals With and Without Shoulder Pain and Myofascial Trigger Points: A Color Doppler Ultrasound and Reliability Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2025; 44:127-136. [PMID: 39360549 DOI: 10.1002/jum.16590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/26/2024] [Accepted: 09/18/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES Myofascial trigger points (MTrPs) are potential contributors to shoulder pain and can lead to local ischemia and hypoxia, thus causing pain. Color Doppler ultrasound (US) has been used to examine the vascular environment around MTrPs, but has not been used to examine blood flow impairments in patients with shoulder pain and MTrPs. The reliability of color Doppler US for measuring infraspinatus muscle blood flow also has not been established. This study aimed to investigate differences in blood flow between individuals with and without shoulder pain and the reliability of Doppler US for measuring infraspinatus muscle blood flow. METHODS Forty participants were enrolled, 20 with shoulder pain and MTrPs and 20 without. Color Doppler US examination was performed twice on each participant to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatile index (PI) of the infraspinatus muscle. RESULTS The symptomatic participants had significantly higher PSV (ie, impaired blood flow) than the asymptomatic participants. There were no significant between-group differences in EDV, RI, and PI. The results also demonstrated good-to-excellent intra-rater reliability for color Doppler US measurements of PSV, EDV, RI, and PI for both groups. CONCLUSION This study demonstrated differences in blood flow near MTrPs in the infraspinatus muscle between individuals with and without shoulder pain. It also established good-to-excellent reliability of color Doppler US in measuring infraspinatus muscle blood flow. These findings suggest color Doppler US is a useful tool to identify vascular impairments for shoulder pain associated with MTrPs.
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Affiliation(s)
- Jace Brown
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Gary Kearns
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Emily Hedges
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Samantha Samaniego
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
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Jayaseelan D, Post A, Sault J, Mischke J. Methodological Variation Among Studies Evaluating Pain Processing in Tendinopathy: A Scoping Review. J Clin Med 2024; 13:7592. [PMID: 39768515 PMCID: PMC11677147 DOI: 10.3390/jcm13247592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 11/22/2024] [Accepted: 12/12/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Objectives: Tendinopathy is a condition associated with pain and limited function. While upper and lower extremity tendinopathies may have different functional implications, there have been a number of reports supporting different patterns of dysfunction in pain processing and inhibition. The purpose of this scoping review was to examine the methods across studies examining pain processing in patients with upper and lower extremity tendinopathy. Methods: Five electronic databases (PubMed, Scopus, CINAHL, the Cochrane Library, and SPORTDiscus) and gray literature sources were searched from inception through 15 April 2024, using appropriate keywords and relevant synonyms. Results: In total, 3219 titles were retrieved from the searches, with 43 studies retained for final inclusion. Of the 43 studies, 22 were specific to upper extremity tendinopathies, 19 were specific to lower extremity tendinopathies, and 2 studies included mixed samples. Physical testing to detect nervous system sensitization was most commonly performed using pressure pain thresholds. Although infrequent, questionnaire instruments were used mostly to include the central sensitization inventory. Substantial variation was noted across studies in mode of testing and instruments used, while patient demographics and inclusion criteria were not clearly reported in many instances. Thirty-one studies (72%) reported nervous system sensitization or dysfunction in tendinopathy, while 13 (28%) did not. Conclusions: While the difference between pain processing in tendinopathy is likely multifactorial, the results of this review identified substantial variability in methodology used and reporting in tendon pain research. As inconsistency in evidence can limit clinical guidance, efforts to standardize tendinopathy pain research appear warranted.
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Affiliation(s)
- Dhinu Jayaseelan
- Program in Physical Therapy, The George Washington University, Washington, DC 20006, USA
| | - Andrew Post
- Division of Rheumatology, Northwestern University, Chicago, IL 60611, USA;
| | - Josiah Sault
- Rehabilitation Services, University of Illinois Hospital and Health Sciences System, Chicago, IL 60611, USA;
| | - John Mischke
- Department of Rehabilitation Science, Tufts University, Seattle, WA 98104, USA;
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Hollis D, Mendis MD, Ng SK, Lewis J, Thomas M, Marks D, Hides J, Bisset L. Altered Sensory Processing in People Attending Specialist Orthopaedic Consultation for Management of Persistent Shoulder Pain: An Observational Cross-Sectional Study. J Orthop Sports Phys Ther 2024; 54:647-656. [PMID: 39329479 DOI: 10.2519/jospt.2024.12512] [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: 09/28/2024]
Abstract
OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups' sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for ≥3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):1-10. Epub 25 July 2024. doi:10.2519/jospt.2024.12512.
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Bilika P, Kalamatas-Mavrikas P, Vasilis N, Strimpakos N, Kapreli E. Reliability of Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in Participants with and without Chronic Shoulder Pain. Healthcare (Basel) 2024; 12:1734. [PMID: 39273758 PMCID: PMC11395602 DOI: 10.3390/healthcare12171734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
The objectives of this study were to estimate the intra-rater and inter-rater reliability of the Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in healthy participants and patients with chronic shoulder pain. Additionally, the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated. Thirty-one healthy volunteers and twenty patients with chronic shoulder pain were assessed using the PPT and CPM by two raters, with a 24 h interval between sessions. Excellent intra-rater reliability was demonstrated for PPT, with similar SEM and SDC when assessed by the same rater. The inter-rater reliability for PPTs in patients was moderate to good (ICC = 0.59-0.89) with higher SEM (73.83-121.98 kPa) and SDC (61.58-97.59) values than the asymptomatic group (ICC = 0.92-0.96, SEM = 49.61-103.12 kPa, SDC = 42.01-56.30) respectively. CPM's intra-rater reliability was good (ICC = 0.82) in the patients and moderate (ICC = 0.67) in the asymptomatic group, while inter-rater reliability was low for the asymptomatic group (ICC = 0.37) and extremely low (ICC = 0.074) for the patients, with comparable SEM and SDC outcomes in both groups. PPT and CPM measurements are highly reliable when conducted by the same rater on the same day. Patients had lower inter-rater PPT reliability but better intra-rater CPM reliability. Clinicians need to be mindful of potential variability when interpreting these test results.
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Affiliation(s)
- Paraskevi Bilika
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 351 32 Lamia, Greece
| | - Panagiotis Kalamatas-Mavrikas
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 351 32 Lamia, Greece
| | - Nikolaos Vasilis
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 351 32 Lamia, Greece
- Go Physio Laboratory, Sports Medicine & Rehabilitation Centre, 106 75 Athens, Greece
| | - Nikolaos Strimpakos
- Health Assessment and Quality of Life Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 351 32 Lamia, Greece
- Division of Musculoskeletal & Dermatological Sciences, Honorary Research Associate, University of Manchester, Manchester M13 9PL, UK
| | - Eleni Kapreli
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 351 32 Lamia, Greece
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Deniz V, Sariyildiz A. Evaluation of the segmental distribution of pain sensitivity among patients with central sensitization associated with chronic subacromial pain syndrome: A cross-sectional study. J Bodyw Mov Ther 2024; 39:176-182. [PMID: 38876623 DOI: 10.1016/j.jbmt.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Pain sensitivity is the main finding of central sensitization (CS) and can occur in patients with chronic shoulder pain. However, there is limited evidence concerning the distribution of pain sensitivity in shoulders, forearms, and legs in patients with CS associated with chronic shoulder pain. The present study aimed to determine the distribution of pain sensitivity in patients with CS associated with chronic subacromial pain syndrome (SPS). METHOD This cross-sectional study included 58 patients with chronic SPS and CS (patient group) and 58 healthy participants (control group). The presence of CS was determined using the Central Sensitization Inventory (CSI). To determine the distribution of pain sensitivity, pressure pain threshold (PPT) measurements were performed from the shoulders, forearms, and legs. RESULTS There was no significant difference between the two groups in terms of sociodemographic data (p > 0.05). The patient group had a significantly higher CSI score (p < 0.001) and lower PPTs in all regions (p < 0.05) than the control group. Unlike the control group, the patient group had lower PPTs on the affected side for the shoulder [mean difference (MD) 95% confidence interval (CI): 1.2 (-1.7 to -0.6)], forearm [MD 95% CI: 1.1 (-1.7 to -0.6)], and leg [MD 95% CI: 0.9 (-1.4 to -0.3)] compared with the contralateral side (p < 0.001). CONCLUSION Pain sensitivity is more pronounced in the affected shoulder and the forearm and leg located on this side than in those on the contralateral side in patients with CS associated with chronic SPS.
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Affiliation(s)
- Volkan Deniz
- Tarsus University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Mersin, Turkey.
| | - Aylin Sariyildiz
- Cukurova University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Adana, Turkey
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Sousa APD, Almeida LA, Lourenço BP, Alvares LD, Avila MA. Pain neuroscience education improves quality of life when added to aquatic exercise therapy for women with fibromyalgia: randomized controlled clinical trial. Disabil Rehabil 2024; 46:1559-1569. [PMID: 37070715 DOI: 10.1080/09638288.2023.2201510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The aim of the present study was to investigate the effects of adding Pain Neuroscience Education (PNE) to an aquatic therapy protocol on pain, fibromyalgia (FMS) impact, quality of life and sleep. MATERIALS AND METHODS Seventy-five women were randomly allocated into two groups: aquatic exercises (AEG, n = 36) and aquatic exercises + PNE (PNG, n = 39). The primary outcome was pain, and the secondary outcomes were FMS impact, quality of life, sleep and pain sensitivity (pressure pain thresholds - PPTs). Participants performed 45-min sessions of aquatic exercises, twice a week, for 12 weeks. PNG also received 4 PNE sessions during this period. Participants were assessed four times: initial (before treatment), after 6 weeks (intermediate) and 12 weeks (final) of treatment and after 12 weeks after the end of treatment (follow-up). RESULTS Both groups improved pain after treatment, with no difference between them (p > 0.05, partial ƞ2 0.10). FMS impact and PPTs improved after treatment with no difference between groups, and sleep did not change. Quality of life improved several domains for both groups, with slightly better results for the PNG, with low effect sizes between groups. CONCLUSIONS The present results show that the addition of PNE to an aquatic exercise intervention did not provide larger effects than aquatic exercises alone for people with FMS concerning pain intensity, but provided benefit for health-related quality of life for this population. TRIAL REGISTRATION ClinicalTrials.gov (NCT03073642, version 2, April 1st, 2019). PERSPECTIVE The addition of 4 Pain Neuroscience Education sessions to an aquatic exercises protocol did not add benefits for women with fibromyalgia syndrome on pain, fibromyalgia impact, and sleep, but improved quality of life and pain sensitivity.IMPLICATIONS FOR REHABILITATIONAquatic exercises are commonly prescribed, but patient education is crucial for the treatment.The addition of Pain Neuroscience Education to an aquatic exercises protocol did not add benefits for women with fibromyalgia syndrome.The positive changes on quality of life and pain sensitivity that this combination led to had small effect sizes and did not achieve minimal important clinical difference.
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Affiliation(s)
- Ana Paula de Sousa
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, Brazil
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Lucas Araújo Almeida
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, Brazil
| | | | - Luiza Duarte Alvares
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Mariana Arias Avila
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, Brazil
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
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Augusto DD, Scattone Silva R, Medeiros Filho JFD, Michener LA, Sousa CDO. Rotator cuff isometric exercises in combination with scapular muscle strengthening and stretching in individuals with rotator cuff tendinopathy: A multiple-subject case report. J Bodyw Mov Ther 2024; 37:164-169. [PMID: 38432800 DOI: 10.1016/j.jbmt.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/25/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE To assess the effects of a rehabilitation protocol of rotator cuff (RC) isometrics coupled with traditional shoulder exercises on patient-rated outcomes, muscle strength, and electromyographic activity in individuals with RC tendinopathy. METHODS Eleven individuals (8 women and 3 men, 37.9 ± 5.6 years) with RC tendinopathy performed isometric RC exercises in combination with scapular muscle stretching and strengthening for 6 weeks. Treatment effects were assessed with patient-rated pain and shoulder function, isometric muscle strength, electromyographic activity during arm elevation and internal and external shoulder rotation, and pain during arm elevation before and at the end of the first session, and after 6 weeks of intervention. RESULTS There were improvements in pain and shoulder function, increased isometric muscle strength for arm elevation and internal rotation, increased muscle activity of the infraspinatus and serratus anterior, and reduced pain during arm elevation after 6 weeks of intervention. DISCUSSION This case report showed improvements on pain and function, increases on isometric strength of the shoulder and on electromyographic activity of the serratus anterior and infraspinatus muscles, as well as decreases on pain during arm elevation, after a 6-week intervention of RC isometric exercises associated with scapular muscle stretching and strengthening in patients with RC tendinopathy.
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Affiliation(s)
- Denise Dal'Ava Augusto
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Rodrigo Scattone Silva
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | | | - Lori Ann Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Rodrigues da Silva Barros B, Dal’Ava Augusto D, de Medeiros Neto JF, Michener LA, Silva RS, Sousa CDO. Isometric versus isotonic exercise in individuals with rotator cuff tendinopathy-Effects on shoulder pain, functioning, muscle strength, and electromyographic activity: A protocol for randomized clinical trial. PLoS One 2023; 18:e0293457. [PMID: 37956135 PMCID: PMC10642785 DOI: 10.1371/journal.pone.0293457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Rotator cuff tendinopathy is a common shoulder disorder in which the primary treatment is resistance exercises. Isometric exercises are being studied for lower limb tendinopathies but not for rotator cuff tendinopathy. This protocol for a randomized clinical trial aims to compare the effects of two types of exercise (isometric and isotonic) on shoulder pain, functioning, muscle strength, and electromyographic activity in individuals with rotator cuff tendinopathy. METHODS Forty-six individuals (18 to 60 years old) with shoulder pain for more than three months and unilateral supraspinatus and/or infraspinatus tendinopathy will participate in this trial. Individuals will be randomized into two exercise groups: isometric or isotonic. The following outcomes will be evaluated before and after the first session and after six weeks of intervention: shoulder pain and functioning; isometric strength of shoulder elevation and lateral and medial rotation; and electromyographic activity of medial deltoid, infraspinatus, serratus anterior, and lower trapezius. Groups will perform stretching and strengthening of periscapular muscles. The isometric group will perform three sets of 32 s, at 70% of maximal isometric strength. The isotonic group will perform concentric and eccentric exercises (2 s for each phase) in three sets of eight repetitions at a load of eight repetition maximum. The total time under tension of 96 s will be equal for both groups, and load will be adjusted in weeks three and five of the protocol. Treatment effect between groups will be analyzed using linear mixed model. TRIAL REGISTRATION Trial registration number: Universal Trial Number (UTN) code U1111-1284-7528 and Brazilian Clinical Trials Registry platform-RBR-3pvdvfk.
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Affiliation(s)
- Bianca Rodrigues da Silva Barros
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | - Denise Dal’Ava Augusto
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | | | - Lori Ann Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
| | - Rodrigo Scattone Silva
- Faculty of Health Sciences of Trairi, Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Santa Cruz, State of Rio Grande do Norte, Brazil
| | - Catarina de Oliveira Sousa
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
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15
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Rebelatto MN, Alburquerque-Sendín F, Gava V, Camargo PR, Haik MN. Cervical sensitivity, range of motion and strength in individuals with shoulder pain: A cross-sectional case control study. Musculoskelet Sci Pract 2023; 67:102834. [PMID: 37527568 DOI: 10.1016/j.msksp.2023.102834] [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: 02/21/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To assess whether cervical sensitivity, range of motion (ROM) and strength are impaired in individuals with shoulder pain and how they interact with sociodemographic and clinical data. METHODS Forty-eight individuals with shoulder pain and 48 asymptomatic matched ones were included. Pressure pain thresholds (PPTs) in cervical region and tibialis anterior muscles, ROM of cervical flexion, extension, lateral flexions and rotations and cervical muscle strength of flexion, extension and lateral flexions were assessed. Between-groups comparisons and a logistic multiple regression model were performed. RESULTS The symptomatic group showed lower and not meaningful PPTs in trapezius of the unaffected/unmatched side, both sternocleidomastoid muscles, and tibialis anterior and reduced ROM in cervical extension (MD = -9.00°) when compared to the asymptomatic group. No differences were identified in muscle strength. Reduced PPT of the trapezius and reduced cervical extension ROM together accounted for 40.2% of the variance of the chance of presenting shoulder pain. CONCLUSION Individuals with shoulder pain have more, but not clinically relevant, cervical sensitivity and lower cervical extension than asymptomatic individuals. The lower the PPT of the upper trapezius and the cervical extension ROM, the higher was the chance to present shoulder pain. Regional interdependence between cervical spine and shoulder may explain cervical physical function alterations in shoulder pain.
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Affiliation(s)
- Marcelo N Rebelatto
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Francisco Alburquerque-Sendín
- Universidad de Córdoba, Department of Nursing, Pharmacology and Physical Therapy, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Vander Gava
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Paula R Camargo
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Melina N Haik
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
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Conte da Silva A, Aily JB, Mattiello SM. Ischemic compression associated with joint mobilization does not promote additional clinical effects in individuals with rotator cuff related shoulder pain: A randomized clinical trial. J Bodyw Mov Ther 2023; 36:335-342. [PMID: 37949581 DOI: 10.1016/j.jbmt.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The objective of this study was to verify which are the additional effects of the ischemic compression (IC) technique associated with joint mobilization techniques on pain, morphological aspects of myofascial trigger points (MTrPs), function, and psychological aspects in individuals with rotator cuff-related shoulder pain (RCRSP). METHODS Sixty individuals with RCRSP were randomly allocated intervention sessions the Mobilization Group (MG, n = 20), only joint mobilizations of the shoulder complex; intervention sessions Compression Group (CG, n = 20), with the same mobilizations associated with the IC over MTrPs; and Placebo Group (PG, n = 20), with the same mobilizations associated with placebo of IC. All interventions performed 2 per week, for 6-weeks. Pain was assessed by Visual Analogue Scale and function by the Disabilities of the Arm, Shoulder and Hand questionnaire. The kinesiophobia, pain catastrophizing, perception of improvement, mobility, pain threshold and area the MTrPs were also evaluated at baseline (week-0), after 6-weeks and after 10-weeks. RESULTS There were no between-group difference in pain: CG-MG 0.8 (95% CI 0.4 to 1.2), CG-PG 0.5 (95% CI 0.0 to 0.9), MG-PG -0.3 (95% CI -0.8 to 0.1) after 6-weeks and CG-MG 0.1 (95% CI -0.2 to 0.5), CG-PG -0.7 (95% CI -0.9 to -0,4), MG-PG -0,8 (95% CI -1.07 to 0.5) at 10-weeks. Similar effects were observed on function, characteristics of MTrPs and psychological aspects. CONCLUSION The IC technique on the MTrPs of the upper trapezius muscle associated with joint mobilization techniques has no additional effect on pain in individuals with RCRSP. TRIAL REGISTRATION RBR-44v8y7.
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Affiliation(s)
| | - Jéssica Bianca Aily
- Physiotherapy Department, Federal University of São Carlos, São Carlos, SP, Brazil.
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17
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Melo ASC, Taylor JL, Ferreira R, Cunha B, Ascenção M, Fernandes M, Sousa V, Cruz EB, Vilas-Boas JP, Sousa ASP. Differences in Trapezius Muscle H-Reflex between Asymptomatic Subjects and Symptomatic Shoulder Pain Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094217. [PMID: 37177422 PMCID: PMC10180810 DOI: 10.3390/s23094217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.
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Affiliation(s)
- Ana S C Melo
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Center for Interdisciplinary Applied Research in Health, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal
| | - Janet L Taylor
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Ricardo Ferreira
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Bruno Cunha
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Manuel Ascenção
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Mathieu Fernandes
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Vítor Sousa
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Eduardo B Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Campus do IPS Estefanilha, 2914-503 Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - J Paulo Vilas-Boas
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Andreia S P Sousa
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
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King J, Shapiro M, Karduna A. Peripheral sensitization is demonstrated in subacromial pain syndrome, with central sensitization found only in females. J Orthop Res 2023; 41:255-262. [PMID: 35488731 PMCID: PMC9617802 DOI: 10.1002/jor.25356] [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: 11/10/2021] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
The objective of this study was to explore whether hypersensitivity in patients with subacromial pain syndrome (SPS) manifests purely as localized peripheral sensitization or central sensitization, is influenced by the presence of subacromial pain, and presents similarly in male and female patients. Pressure pain threshold was assessed in both a patient cohort with unilateral SPS and an uninjured matched control group. Control subjects were assessed twice, with a 15 minute rest period between testing, while patients were assessed at baseline and after an almost instantaneous reduction in pain arising from an anesthetic injection in patients. Patients received a subacromial injection consisting of both anesthetics (3 cc of 2% lidocaine and 6 cc 0.5% Marcaine with Epinephrine) and a corticosteroid agent (1 cc DepoMedrol). Patients demonstrated hypersensitivity across the involved shoulder only, providing evidence for peripheral sensitization. There were trends for hypersensitivity across remote joints, however when separated by sex, only female patients demonstrated both peripheral and central sensitization. Immediate pain reduction had no influence on hypersensitivity in the short-term. Clinical Significance: Neuropathic components are likely present in some patients with subacromial pain syndrome, and female patients may be particularly at risk for presenting with neuropathic pain. These findings are applicable towards understanding the heterogeneous etiology underlying subacromial pain syndrome and informing clinical management.
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Affiliation(s)
- Jacqlyn King
- Innovation & Success Center, College of Southern Idaho, Twin Falls, ID
| | | | - Andrew Karduna
- Department of Human Physiology, University of Oregon, Eugene, OR
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Azin Z, Kamali F, Salehi Dehno N, Abolahrari-Shirazi S. Comparison of Manual Therapy Technique to Therapeutic Exercise in the Treatment of Patients With Subacromial Impingement Syndrome: A Randomized Clinical Trial. J Manipulative Physiol Ther 2023; 46:98-108. [PMID: 37777940 DOI: 10.1016/j.jmpt.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of manual therapy to therapeutic exercise on shoulder pain, disability, and range of motion (ROM) in patients with subacromial impingement syndrome (SAIS). METHODS Sixty patients with SAIS were randomly assigned into the manual therapy (MT) and therapeutic exercise (TE) groups. Patients in the MT group were treated with joint mobilization, which was applied to the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints, and trigger point (TrP) inactivation using ischemic compression. Patients in the TE group performed therapeutic exercises. Shoulder pain, disability and active ROM (elevation, external rotation, and internal rotation) were assessed by the visual analog scale, the Shoulder Pain and Disability Index, and a goniometer, respectively. The outcomes were measured at baseline, after the intervention, and 1 month after the intervention. RESULTS After the treatment, both groups had significant improvements in shoulder pain, disability, and ROM (P < .05). The MT group experienced a greater reduction in shoulder pain than the TE group (P < .001). However, in disability and ROM, both groups exhibited similar improvements in post-treatment and follow-up periods. CONCLUSION Both MT and TE were effective in improving shoulder pain, disability, and ROM in patients with SAIS. Greater improvement in shoulder pain was observed in the MT group.
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Affiliation(s)
- Zeynab Azin
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Salehi Dehno
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Abolahrari-Shirazi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Othman R, Swain N, Tumilty S, Jayakaran P, Mani R. Sensitivity to movement-evoked pain, central sensitivity symptoms, and pro-nociceptive profiles in people with chronic shoulder pain: A parallel-group cross-sectional investigation. Pain Pract 2023; 23:41-62. [PMID: 36617189 DOI: 10.1111/papr.13152] [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: 02/17/2022] [Revised: 06/25/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate whether sensitivity to movement-evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain. METHODS People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between-group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses. RESULTS Dynamic mechanical allodynia, mechanical temporal summation, movement-evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro-nociceptive profiles and experienced higher pain severity, interference, and disability. CONCLUSIONS People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain.
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Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- 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
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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21
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Tavares LF, Gadotti IC, Ferreira LM, Maciel ACC, Carvalho BG, Barbosa GS, Almeida EO, Ribeiro KF. Pain, deep neck flexors performance, disability, and head posture in individuals with temporomandibular disorder with and without otological complaints. J Back Musculoskelet Rehabil 2022; 36:465-475. [PMID: 36404529 DOI: 10.3233/bmr-220079] [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: 11/16/2022]
Abstract
BACKGROUND Otological complaints (OC) are highly prevalent in subjects with temporomandibular disorders (TMD) and so is the risk of neck dysfunctions. OBJECTIVE To evaluate pain, deep neck flexor (DNF) performance, disability, and head and neck posture of individuals with TMD with and without OC. METHODS In this cross-sectional study, 57 individuals were divided into a group with TMD and OC (n= 31) and a group with TMD without OC (n= 26). Self-reported pain intensity, masticatory and neck muscles pressure pain thresholds, DNF performance, neck disability, and head and neck posture were evaluated. Data were compared between groups using the independent t test and Mann-Whitney test with Bonferroni correction for multiple comparisons. Effect sizes were evaluated using Cohen's index. RESULTS The TMD with OC group presented less muscle activation [26 (24-28) vs. 24 (24-26) mmHg; p< 0.05], less endurance [105 (46-140) vs. 44 (28-78) points; p< 0.05], and greater neck disability (8.15 ± 5.89 vs. 13.32 ± 6.36 points; p< 0.05). No significant difference was observed in self-reported pain, head and neck posture, or pressure pain thresholds. CONCLUSION Individuals with TMD with OC presented decreased DNF performance and increased neck disability compared to individuals with TMD without OC.
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Affiliation(s)
- Luiz Felipe Tavares
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brasil
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22
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Previtali D, Mameli A, Zaffagnini S, Marchettini P, Candrian C, Filardo G. Tendinopathies and Pain Sensitisation: A Meta-Analysis with Meta-Regression. Biomedicines 2022; 10:1749. [PMID: 35885054 PMCID: PMC9313266 DOI: 10.3390/biomedicines10071749] [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: 06/08/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
The presence of pain sensitisation has been documented and reported as being a possible cause of treatment failure and pain chronicity in several musculoskeletal conditions, such as tendinopathies. The aim of the present study is to analyse existing evidence on pain sensitisation in tendinopathies comparing the local and distant pain thresholds of healthy and affected subjects with distinct analysis for different tendinopathies. PubMed, Cochrane Central Register, Scopus, and Web Of Science were systematically searched after registration on PROSPERO (CRD42020164124). Level I to level IV studies evaluating the presence of pain sensitisation in patients with symptomatic tendinopathies, documented through a validated method, were included. A meta-analysis was performed to compare local, contralateral, and distant pain thresholds between patients and healthy controls with sub-analyses for different tendinopathies. Meta-regressions were conducted to evaluate the influence of age, activity level, and duration of symptoms on results. Thirty-four studies out of 2868 were included. The overall meta-analysis of local pressure pain thresholds (PPT) documented an increased sensitivity in affected subjects (p < 0.001). The analyses on contralateral PPTs (p < 0.001) and distant PPTs (p = 0.009) documented increased sensitivity in the affected group. The results of the sub-analyses on different tendinopathies were conflicting, except for those on lateral epicondylalgia. Patients’ activity level (p = 0.02) and age (p = 0.05) significantly influenced local PPT results. Tendinopathies are characterized by pain sensitisation, but, while features of both central and peripheral sensitisation can be constantly detected in lateral epicondylalgia, results on other tendinopathies were more conflicting. Patients’ characteristics are possible confounders that should be taken into account when addressing pain sensitisation.
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Affiliation(s)
- Davide Previtali
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
| | - Alberto Mameli
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Paolo Marchettini
- Fisiopatologia e Terapia del Dolore, Dipartimento di Farmacologia, Careggi Università di Firenze, 50134 Firenze, Italy;
- Terapia del Dolore, Centro Diagnostico Italiano, 20147 Milan, Italy
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland; (A.M.); (C.C.); (G.F.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Nascimento JDSD, Alburquerque-Sendín F, Souza LMVD, Sousa CDO. Relationships Between Active Myofascial Trigger Points and Depressive Symptoms and Physical and Clinical Characteristics of Individuals With Shoulder Pain: A Cross-sectional Study. J Chiropr Med 2022; 21:249-259. [DOI: 10.1016/j.jcm.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 10/17/2022] Open
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Intelangelo L, Bordachar D, Mendoza C, Lassaga I, Barbosa AC, Manresa JB, Mista C. Pressure pain threshold mappings of the infraspinatus muscle in chronic unilateral shoulder pain patients do not reflect generalized hypersensitivity. Musculoskelet Sci Pract 2022; 58:102495. [PMID: 35114503 DOI: 10.1016/j.msksp.2021.102495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Increased mechanical sensitivity has been observed on the unaffected side in chronic pain conditions, suggesting generalized or widespread hypersensitivity. However, this cannot be considered as a universal response since this hypersensitivity is inconsistent across muscle pain pathologies. The aim of this study was to assess generalized hypersensitivity in chronic unilateral shoulder pain, using pressure pain threshold (PPT) mappings of the infraspinatus muscle. The proposed evaluation is based on the assessment of PPT on a limited subset of sites, reducing potential habituation or sensitization effects. METHODS Twenty-nine patients with unilateral shoulder pain (USP) and twenty-seven healthy volunteers were recruited. PPT was assessed using a manual pressure algometer. Six sites distributed over the infraspinatus muscle were assessed, and three repetitions were performed at each site. Mappings were derived using two-dimensional interpolation. RESULTS Lower PPT values were found in the symptomatic side in comparison with the asymptomatic side at all assessment sites (estimated difference: 1.42 ± 0.10 kgf/cm2, p < 0.001), but there were no differences among the asymptomatic side of USP patients and any of the sides in healthy volunteers (largest estimated difference: 0.17 ± 0.28 kgf/cm2, p = 0.927). Furthermore, the medial region of the infraspinatus muscle showed higher mechanical sensitivity in both healthy volunteers and USP patients. CONCLUSIONS These results suggest that USP does not induce generalized hypersensitivity, in contrast with previously reported findings. Physiotherapists could take these results into account for the assessment and treatment of patients with USP.
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Affiliation(s)
- Leonardo Intelangelo
- Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, Rosario, Argentina.
| | - Diego Bordachar
- Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, Rosario, Argentina
| | - Cristian Mendoza
- Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, Rosario, Argentina
| | - Ignacio Lassaga
- Musculoskeletal Research Unit - UIM, University Center for Assistance, Teaching and Research - CUADI, University of Gran Rosario - UGR, Rosario, Argentina
| | - Alexandre Carvalho Barbosa
- Department of Physical Therapy, Musculoskeletal Research Group - NIME, Federal University of Juiz de Fora, Brazil
| | - José Biurrun Manresa
- Institute for Research and Development on Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina; Center for Neuroplasticity and Pain (CNAP), SMI®, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Mista
- Institute for Research and Development on Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina
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Ge M, Zhang Y, Li Y, Feng C, Tian J, Huang Y, Zhao T. Publication Trends and Hot Spots in Subacromial Impingement Syndrome Research: A Bibliometric Analysis of the Web of Science Core Collection. J Pain Res 2022; 15:837-856. [PMID: 35370418 PMCID: PMC8974249 DOI: 10.2147/jpr.s348528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background In recent years, the research on subacromial impingement syndrome (SIS) has gradually increased. Although the research directions are diverse, the overall research status and trend are not clear. Objective The aim of our study was to use bibliometric analysis to identify the trends in SIS-related research and to analyze the most highly cited scientific publications on SIS. Methods All data were retrieved from the Web of Science Core Collection database, and the year of publications, countries, journals, institutions and total number of citations were extracted and analyzed. The results related to countries, institutions and keywords were then analyzed using VOSviewer software and bibliometrics online analysis platform. And, we also identified the 100 most cited articles on SIS. Results A total of 548 articles related to AIS were identified. The frequency of publication on SIS has increased substantially over time. Among all countries, Turkey has contributed the most publications on SIS (n=118). The institution with the most articles was Istanbul University (n=17). Journal of Shoulder and Elbow Surgery topped the list of journals and has published 19 SIS-related publications. The hotspot of research changed from the former arthroscopic surgery to physical therapy and rehabilitation. Conclusion The scientific research on SIS has rapidly expanded in recent years. This study represents the first bibliometric analysis of SIS, gives us a systematic and comprehensive summary into the development of SIS.
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Affiliation(s)
- Meng Ge
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yuan Zhang
- Bengbu Medical College, Bengbu, People's Republic of China
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Chenchen Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
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Arjun MV, Rajaseker S. Association between subscapularis trigger point and frozen shoulder: A cross sectional study. J Bodyw Mov Ther 2021; 28:406-410. [PMID: 34776170 DOI: 10.1016/j.jbmt.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/02/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Frozen shoulder (FS) is one of the most common shoulder conditions characterized by pain, restricted range of motion and high morbidity. Though FS is known as adhesive capsulitis, presence of capsular adhesions has been rebutted and the nomenclature adhesive capsulitis is debated. It has been proposed that FS is a condition of cytokine driven capsular, ligamentous fibrosis and contracture. Despite extensive research on it, still it is unclear that how far the capsular contracture contribute to range of motion restriction in FS. Evidence also suggested that myofascial trigger points play a role in restricted range of motion. OBJECTIVE To find an association between subscapularis trigger point and frozen shoulder. STUDY DESIGN Cross-sectional study. METHOD 143 Patients were screened for inclusion and exclusion criteria, out of which 100 patients, were selected for the study. Manual palpation was performed to look for subscapularis muscle trigger points via axillary approach on both the affected and unaffected side. Trigger point diagnosing criteria was used to diagnose subscapularis trigger points. RESULTS Results have shown that there was an association between subscapularis trigger point and frozen shoulder (X 2 = 32.151 P < 0.0001) on the affected side. We used Phi coefficient to measure the degree of association which denotes (Phi = 0.567 P < 0.0001) strong association between frozen shoulder and subscapularis trigger point on the affected side compared to unaffected side (X 2 9.157; P < 0.002: Phi:0.303: P < 0.002). CONCLUSION This study concluded that there appears to be a strong association between subscapularis trigger point and frozen shoulder.
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Affiliation(s)
- M V Arjun
- College of Physiotherapy, Srinivas University, Mangaluru, India.
| | - S Rajaseker
- College of Physiotherapy Srinivas University, Mangaluru, India.
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Effect of different postures of the scapular girdle and arm on the pressure pain threshold in the infraspinatus muscle. J Bodyw Mov Ther 2021; 28:276-282. [PMID: 34776153 DOI: 10.1016/j.jbmt.2021.08.001] [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: 10/29/2020] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. METHODS This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. RESULTS No differences were observed between groups. The within-group analysis showed differences for both factors: "Positions" (F = 69.91; p = 0.001) and the interaction "Positions^Group" (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. CONCLUSION Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.
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Signs of Central Hypersensitivity, Stress, and Anxiety following Treatment for Breast Cancer: A Case Control Study. Int J Breast Cancer 2021; 2021:5691584. [PMID: 34707910 PMCID: PMC8545580 DOI: 10.1155/2021/5691584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022] Open
Abstract
Background With treatment for breast cancer, women treated may present significant sensory abnormalities in the upper extremity. However, there are no conclusive studies that have evaluated pressure pain thresholds (PPT) in the shoulder of postoperated women for breast cancer. The aim of this study was to compare PPT in the shoulder, stress, anxiety, depression symptoms, and quality of sleep among postoperated women for breast cancer (PO group) and asymptomatic women of shoulder pain (control group). Methods 40 women participated (n = 20, PO group, age: average ± standard deviation, 49.2 ± 8.3 years; body mass index (BMI): 27.5 ± 3.0 kg/cm2; surgery time: 22.2 ± 34.4 months; n = 20, control group, 46.9 ± 8.1 years; BMI: 26.8 ± 3.5 kg/cm2). The PPT was evaluated with a digital algometer at 32 points in the shoulder region and one control point in the tibialis anterior. Stress, anxiety, and depression were evaluated with the Depression, Anxiety and Stress Scale 21 (DASS-21) and the quality of sleep by the Pittsburgh Sleep Quality Index. Results Significant differences were observed over 1.5 kgf/cm2 in 33 points evaluated (p < 0.01) with a small to high effect size (Cliff's delta range = 0.16; 0.92) and higher levels of anxiety and stress in the PO group (anxiety: median [first; third quartile], 5[3; 12.5]; stress: 9.7 ± 4.7 (7.8; 11.8)) in comparison with the control group (anxiety: 2.5[1; 4.8]; stress: 6.7 ± 3.31 (5.2; 8.3), (p < 0.05)). No significant differences were found between the groups in depression and sleep quality (p > 0.05). Conclusion Postoperated women for breast cancer present hyperalgesia in the shoulder anterior and posterior region, low PPT in the tibialis anterior, and higher levels of stress and anxiety compared to the control group.
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Othman R, Swain N, Tumilty S, Jayakaran P, Mani R. Pro-nociceptive pain modulation profile in patients with acute and chronic shoulder pain: a hypothesis-generating topical review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1973776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- 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
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
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High Rate of Pain Sensitization in Musculoskeletal Shoulder Diseases: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:237-248. [PMID: 33399396 DOI: 10.1097/ajp.0000000000000914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain sensitization, defined as an increased responsiveness of nociceptive neurons to normal input, is detected in several musculoskeletal diseases, but there are no systematic reviews or meta-analyses about pain sensitization in shoulder pain. OBJECTIVES The aim of the study was to document pain sensitization rate and its impact in patients with shoulder pain. MATERIALS AND METHODS PubMed, Cochrane Library, and Web of Science were searched on January 8, 2020. Level I-IV studies, evaluating pain sensitization in musculoskeletal shoulder disorders through validated methods (questionnaires/algometry) were included. The primary outcome was pain sensitization rate. Secondary outcomes were the pain sensitivity level measured as pressure pain threshold, temporal summation, conditioned pain modulation, and suprathreshold heat pain response. Associated demographic and psychosocial factors were evaluated. RESULTS The rate of abnormal pressure pain threshold in patients with shoulder pain varied from 29% to 77%. Questionnaires detected pain sensitization in 11% to 24% of patients. This meta-analysis showed no difference in pressure pain threshold and central pain modulation but documented a significant difference in terms of suprathreshold heat pain response, indicating a hypersensitivity state in patients with shoulder pain versus asymptomatic controls. The only factor that was constantly found to correlate with higher sensitivity was a lower postoperative outcome. DISCUSSION Pain sensitization has a high rate among patients with musculoskeletal shoulder pain, regardless of the specific etiology, and this may lead to worse clinical outcome after treatment of the primary disease. The best way to assess pain sensitization still needs to be identified as the assessment methods results in used high variability in the documented pain sensitization rate.
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Fernández-de-Las-Peñas C, Navarro-Santana MJ, Cleland JA, Arias-Buría JL, Plaza-Manzano G. Evidence of Bilateral Localized, but Not Widespread, Pressure Pain Hypersensitivity in Patients With Upper Extremity Tendinopathy/Overuse Injury: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6275369. [PMID: 33989399 DOI: 10.1093/ptj/pzab131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/11/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The presence of altered nociceptive pain processing in patients with upper extremity tendinopathy/overuse injury is conflicting. Our aim was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas between patients with upper extremity tendinopathy/overuse injury and controls. METHODS Five databases were searched from inception to October 15, 2020. The authors selected case-control studies comparing PPTs between individuals with upper extremity tendinopathy/overuse injury and pain-free controls. Data were extracted for population, diagnosis, sample size, outcome, and type of algometer. Results were extracted by 3 reviewers. The methodological quality/risk of bias (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development and Evaluation approach) were assessed. Meta-analyses of symptomatic, segment-related, and distant pain-free areas were compared. RESULTS The search identified 807 publications with 19 studies (6 shoulder, 13 elbow) eligible for inclusion. The methodological quality ranged from fair (48%) to good (37%). Patients exhibited lower bilateral PPTs than controls at the symptomatic area (affected side: MD = -175.89 kPa [95% CI = -220.30 to -131.48 kPa]; nonaffected side: MD = -104.50 kPa [95% CI = -142.72 to -66.28 kPa]) and the segment-related area (affected side: MD = -150.63 kPa [95% CI = -212.05 to -89.21 kPa]; nonaffected side: MD = -170.34 kPa [95% CI = - 248.43 to -92.25]) than controls. No significant differences in PPTs over distant pain-free areas were observed. CONCLUSION Low to moderate quality evidence suggests bilateral hypersensitivity to pressure pain at the symptomatic and contralateral/mirror areas in patients with upper extremity tendinopathies/overuse injury. Moderate quality of evidence supports bilateral pressure pain sensitivity in the segment-related area (neck) in lateral epicondylalgia, but not in subacromial impingement syndrome. No evidence of widespread pressure pain hyperalgesia was reported. IMPACT Early identification of people with altered pain modulation could guide clinicians in treatment strategies. This review shows that there is a complex interplay between peripheral and central pain mechanisms in upper extremity tendinopathies/overuse injuries and that there likely are different subgroups of patients with upper extremity conditions.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain
| | - Marcos J Navarro-Santana
- Radiology, Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, Madrid, Spain.,Department of Physical Therapy, Rehabilitación San Fernando, Madrid, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Radiology, Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Rosa DP, Borstad JD, Ferreira JK, Gava V, Santos RV, Camargo PR. Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial. Braz J Phys Ther 2021; 25:648-658. [PMID: 34001426 DOI: 10.1016/j.bjpt.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. OBJECTIVE To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. METHODS In this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. RESULTS Individuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P<.01; MD=-0.7mm; 95%CI=-1.3mm, -0.2mm) and superior (P<.01; MD=-0.5mm; 95%CI=-0.9mm, -0.2mm) humeral translations, decreased SPADI score (P<.01; MD=-23.6; 95%CI=-28.7, -18.4), increased IR ROM (P<.01; MD=4.6°; 95%CI=1.8°, 7.8°) and PPTs for upper trapezius (P<.01; MD=60.1kPa; 95%CI=29.3kPa, 90.9kPa), infraspinatus (P=.04; MD=47.3kPa; 95%CI=2.1kPa, 92.5kPa), supraspinatus (P<.01; MD=63.7kPa; 95%CI=29.6kPa, 97.9kPa), and deltoid (P<.01; MD=40.9kPa; 95%CI=12.3kPa, 69.4kPa) after treatment. CONCLUSION The experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.
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Affiliation(s)
- Dayana P Rosa
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - John D Borstad
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN, USA
| | - Julia K Ferreira
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Vander Gava
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Rodrigo V Santos
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Paula R Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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Rampazo ÉP, da Silva VR, de Andrade ALM, Back CGN, Madeleine PM, Arendt-Nielsen L, Liebano RE. Sensory, Motor, and Psychosocial Characteristics of Individuals With Chronic Neck Pain: A Case-Control Study. Phys Ther 2021; 101:pzab104. [PMID: 33774667 DOI: 10.1093/ptj/pzab104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Given the complex and unclear etiology of neck pain, it is important to understand the differences in central sensitization as well as psychosocial factors in individuals with chronic neck pain and healthy controls. The purpose of this study was to benchmark differences in central sensitization, psychosocial factors, and range of motion between people with nonspecific chronic neck pain and healthy controls and to analyze the correlation between pain intensity, neck disability, and psychosocial factors in people with chronic neck pain. METHODS Thirty individuals with chronic neck pain and 30 healthy controls were included in this case-control study. Outcome measures were as follows: central sensitization (pressure pain threshold, temporal summation, and conditioned pain modulation), psychosocial factors (depressive symptoms, pain catastrophizing, and quality of life), and active cervical range of motion. RESULTS People with neck pain had lower local pressure pain threshold, a decrease in conditioned pain modulation, more depressive symptoms, greater pain catastrophizing, lower quality of life, and reduced range of motion for neck rotation when compared with healthy controls. In people with neck pain, moderate correlations were observed between pain intensity and quality of life (ρ = -0.479), disability and pain catastrophizing (ρ = 0.379), and disability and quality of life (ρ = -0.456). CONCLUSIONS People with neck pain have local hyperalgesia, impaired conditioning pain modulation, depressive symptoms, pain catastrophizing, low quality of life, and reduced active range of motion during neck rotation, which should be taken into account during assessment and treatment. IMPACT This study shows that important outcomes, such as central sensitization and psychosocial factors, should be considered during assessment and treatment of individuals with nonspecific chronic neck pain. In addition, pain intensity and neck disability are correlated with psychosocial factors.
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Affiliation(s)
- É P Rampazo
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - V R da Silva
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - A L M de Andrade
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - C G N Back
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil
| | - P M Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - L Arendt-Nielsen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology School of Medicine, Aalborg University, Aalborg, Denmark
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP Brazil, CEP: 13565-905
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Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2021; 51:72-81. [PMID: 32857944 DOI: 10.2519/jospt.2021.9785] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). DESIGN Randomized, single-blinded, multicenter parallel-group trial. METHODS Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. RESULTS At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). CONCLUSION Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. J Orthop Sports Phys Ther 2021;51(2):72-81. Epub 28 Aug 2020. doi:10.2519/jospt.2021.9785.
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The effect of dry needling & muscle energy technique separately and in combination in patients suffering shoulder impingement syndrome and active trigger points of infraspinatus. J Bodyw Mov Ther 2020; 26:94-100. [PMID: 33992303 DOI: 10.1016/j.jbmt.2020.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 09/09/2020] [Accepted: 12/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of a combination of dry needling (DN) and muscle energy technique (MET) on pain intensity (PI), pressure pain threshold (PPT) and shoulder active range of motion (ROM) in patients with shoulder impingement syndrome and active trigger points in the infraspinatus muscle. METHODS 39 patients, aged 20-50 participated in this study. All the cases were randomly assigned into three groups: group 1 (n = 13) received DN, group 2 (n = 13) received MET, and group 3 (n = 13) received DN & MET. The patients were treated for three sessions in a one-week period with at least a two-day break between sessions. RESULTS The results showed a significant improvement in visual analog scale (VAS), PPT and shoulder ROM over time (P < 0.001) in all three groups. There were no significant differences BETWEEN VAS (P = 0.406) PPT (P = 0.293), external rotation(EXT.ROT) (0.476), internal rotation (INT.ROT)(P = 0.476) and extension(EXT) (P = 0.574) ROMs in the three groups; however, DN group was significantly more effective on abduction(ABD) (P = 0.003) and flexion(FLEX) (0.012) ROM compared with other two groups. CONCLUSION In line with previous studies, the present study found that the application of DN, MET and combined of these treatment on active trigger points in the infraspinatus muscle of patients with shoulder impingement syndrome helps reduce pain, increase PPT and enhance the shoulder ROM. Both techniques are effective in the treatment of trigger points. Nevertheless, DN is more effective in enhancing the ROM of flexion & abduction.
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Li L, Stoop R, Clijsen R, Hohenauer E, Fernández-de-Las-Peñas C, Huang Q, Barbero M. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain 2020; 36:955-967. [PMID: 32841969 DOI: 10.1097/ajp.0000000000000875] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to conduct an updated systematic review of diagnostic criteria for myofascial trigger points (MTrPs) used in clinical trials of physical therapy interventions from 2007 to 2019. METHODS MEDLINE and Physiotherapy Evidence Database (PEDro) were searched using the following MeSH keywords: "trigger points," "trigger point," "myofascial trigger point," "myofascial trigger points," "myofascial pain," and "myofascial pain syndrome." The MeSH keywords were combined by using Boolean operators "OR"/"AND." All physiotherapy clinical trials including patients with musculoskeletal conditions characterized by at least 1 active MTrP or latent MTrP in any body area were selected. We pooled data from an individual criterion and criteria combinations used to diagnose MTrPs. The protocol was developed in accordance with the PRISMA-P guidelines. RESULTS Of 478 possibly relevant publications, 198 met the inclusion criteria. Of these 198 studies, 129 studies (65.1%) stated specifically the diagnostic criteria used for MTrPs in the main text, 56 studies (28.3%) failed to report any method whereby MTrP was diagnosed, and 13 studies (6.6%) adopted expert-based definitions for MTrPs without specification. Of 129 studies, the 6 criteria applied most commonly were: "spot tenderness" (n=125, 96.9%), "referred pain" (95, 73.6%), "local twitch response" (63, 48.8%), pain recognition (59, 45.7%), limited range of motion" (29, 22.5%), and "jump sign" (10, 7.8%). Twenty-three combinations of diagnostic criteria were identified. The most frequently used combination was "spot tenderness," "referred pain," and "local twitch response" (n=28 studies, 22%). CONCLUSIONS A number of the included studies failed in properly reporting the MTrP diagnostic criteria. Moreover, high variability in the use of MTrP diagnostic was also observed. Spot tenderness, referred pain, and local twitch response were the 3 most popular criteria (and the most frequently used combination). A lack of transparency in the reporting of MTrP diagnostic criteria is present in the literature. REGISTRY This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO number: CRD42018087420.
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Affiliation(s)
- Lihui Li
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- School of Medicine, Southern University of Science and Technology, Shenzhen
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Rahel Stoop
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
| | - Ron Clijsen
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erich Hohenauer
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Qiangmin Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
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Haik MN, Alburquerque-Sendín F, Fernandes RAS, Kamonseki DH, Almeida LA, Liebano RE, Camargo PR. Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis. Diagnostics (Basel) 2020; 10:diagnostics10110928. [PMID: 33182699 PMCID: PMC7696199 DOI: 10.3390/diagnostics10110928] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 01/10/2023] Open
Abstract
Biopsychosocial aspects seem to influence the clinical condition of rotator cuff related shoulder pain (RCRSP). However, traditional bivariate and linear analyses may not be sufficiently robust to capture the complex relationships among these aspects. This study determined which biopsychosocial aspects would better classify individuals with acute and chronic RCRSP and described how these aspects interact to create biopsychosocial phenotypes in individuals with acute and chronic RCRSP. Individuals with acute (<six months of pain, n = 15) and chronic (≥six months of pain, n = 38) RCRSP were included. Sociodemographic data, biological data related to general clinical health status, to shoulder clinical condition and to sensory function, and psychosocial data were collected. Outcomes were compared between groups and a decision tree was used to classify the individuals with acute and chronic RCRSP into different phenotypes hierarchically organized in nodes. Only conditioned pain modulation was different between the groups. However, the tree combined six biopsychosocial aspects to identify seven distinct phenotypes in individuals with RCRSP: three phenotypes of individuals with acute, and four with chronic RCRSP. While the majority of the individuals with chronic RCRSP have no other previous painful complaint besides the shoulder pain and low efficiency of endogenous pain modulation with no signs of biomechanical related pain, individuals with acute RCRSP are more likely to have preserved endogenous pain modulation and unilateral pain with signs of kinesiophobia.
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Affiliation(s)
- Melina N Haik
- Department of Physical Therapy, Center of Health and Sport Science (CEFID), Universidade do Estado de Santa Catarina, Rua Pascoal Simone 358, Florianópolis, SC 88080-350, Brazil
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
- Correspondence:
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain;
| | - Ricardo A S Fernandes
- Department of Electrical Engineering, Center for Exact Sciences and Technology (CCET), Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil;
| | - Danilo H Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
| | - Lucas A Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
| | - Richard E Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil;
| | - Paula R Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
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The MyotonPRO: A reliable tool for quantifying the viscoelastic properties of a trigger point on the infraspinatus in non-traumatic chronic shoulder pain. J Bodyw Mov Ther 2020; 24:379-385. [DOI: 10.1016/j.jbmt.2020.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
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Liaghat B, Eshoj H, Juul-Kristensen B, Arendt-Nielsen L, Skou ST. Pressure pain sensitivity in patients with traumatic first-time and recurrent anterior shoulder dislocation: a cross-sectional analysis. Scand J Pain 2020; 20:387-395. [PMID: 31586969 DOI: 10.1515/sjpain-2019-0091] [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: 06/28/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Traumatic anterior shoulder dislocation (ASD) is frequent in active populations and associated with a 39% higher risk of recurrent dislocation, which may cause persistent shoulder problems, pain, and impaired shoulder-related quality of life. While local and distant pressure pain sensitivity has been demonstrated in other shoulder conditions, little is known about the link between pressure pain sensitivity and ASD. The interesting aspect is whether recurrent dislocation - resulting in symptoms of longer duration - is associated with more pronounced pressure pain sensitivity, or if presence of pressure pain sensitivity may be part of the reasons why patients develop recurrent dislocation. Therefore, this study aimed at evaluating whether patients with recurrent ASD display greater pressure pain sensitivity and more painful body sites than patients with first-time ASD. Methods This was a cross-sectional analysis of baseline data from a randomized controlled trial including 34 patients with first-time ASD [82% male, mean (SD) age 26 (7) years] and 22 patients with recurrent ASD [96% male, mean (SD) age 25 (5) years]. Patients were assessed as follows: (1) assessment of local and distant pressure pain sensitivity evaluated by pressure pain thresholds (PPTs) using a handheld algometer on mm. trapezius superior, levator scapula, pectorales major, deltoideus, and tibialis anterior, (2) pain intensity at rest during the previous 24 h, (3) number of ASD, and (4) number of painful body sites on a region-divided body chart. Results The PPTs were not significantly different between first-time and recurrent ASD [mean (SD) kPa for m. trapezius superior 264 (110) vs. 261 (88), m. levator scapula 301 (157) vs. 325 (163), m. pectorales major 234 (163) vs. 269 (130), m. deltoideus 290 (166) vs. 352 (173), m. tibialis anterior 420 (202) vs. 449 (184)], two-way ANCOVA, adjusted for sex and age, F (4,263) = 0.29, p = 0.88. For both groups, the PPTs were lower at the shoulder sites than at m. tibialis anterior (difference 117-184 kPa, 95% CI range 33-267). Females had lower PPTs than males (difference 124 kPa, 95% CI 64-183). The number (SD) of painful body sites were 2.2 (1.9) for first-time ASD and 2.6 (5.4) for recurrent ASD, with no between-group differences, one-way ANCOVA, adjusted for sex and age, F (1, 52) = 0.24, p = 0.63. There was a strong correlation between PPTs at the shoulder and lower leg, r = 0.84, p < 0.01. Conclusions This study demonstrated no differences in local and distant pressure pain sensitivity or number of painful body sites between patients with first-time and recurrent ASD. Females had lower PPTs than males, and a strong correlation was found between PPTs at the shoulder and lower leg. Implications Patients with first-time and recurrent ASD seem to have similar pressure pain sensitivity, but lower PPTs compared to existing normative data, suggesting that it is relevant to evaluate the status of the pain system in these patients to prevent triggering or worsening of their symptoms. However, it remains unanswered how these changes affect the patients' ability to undergo rehabilitation, symptom response and long-term shoulder function.
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Affiliation(s)
- Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Eshoj
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Quality of Life Research Center, Odense University Hospital, Department of Haematology, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Rampazo ÉP, de Andrade ALM, da Silva VR, Back CGN, Liebano RE. Photobiomodulation therapy and transcutaneous electrical nerve stimulation on chronic neck pain patients: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19191. [PMID: 32080103 PMCID: PMC7034724 DOI: 10.1097/md.0000000000019191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic neck pain is a common musculoskeletal disorder that is associated with functional disability and decreased of quality of life. Electrophysical agents are commonly used to relieve pain, however the effects of combined use of these agents are little studied. The objective is to investigate the efficacy of photobiomodulation and electrical stimulation to relieve pain, both in isolation and combined. MATERIALS AND METHODS This a 4-arm randomized placebo-controlled trial with patient and evaluator blinded. This study will be performed in Department of Physical Therapy at Federal University of São Carlos, São Carlos/SP, Brazil. One hundred and forty-four patients with chronic neck pain will be randomized into 4 groups: active photobiomodulation therapy with active electrical stimulation, active photobiomodulation therapy, active electrical stimulation, or placebo treatment. They will receive 10 sessions of treatment. PRIMARY OUTCOME pain intensity (measured by pain numerical rating scale) posttreatment. SECONDARY OUTCOMES pain during movement, neck disability, range of motion, pressure pain threshold, temporal summation, conditioned pain modulation, depressive symptoms, pain catastrophizing, quality of life, analgesic intake, and global perceived effect at posttreatment (10 sessions). Pain intensity and global perceived effect will also be measured after 6 weeks randomization. DISCUSSION The findings of this study might clarify the importance of using the photobiomodulation therapy and transcutaneous electrical nerve stimulation for patients with chronic neck pain. TRIAL REGISTRATION NCT04020861. https://clinicaltrials.gov/ct2/show/NCT04020861?term=NCT04020861&draw=2&rank=1.
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Nascimento JDSD, Alburquerque-Sendín F, Vigolvino LP, Oliveira WFD, Sousa CDO. Absolute and Relative Reliability of Pressure Pain Threshold Assessments in the Shoulder Muscles of Participants With and Without Unilateral Subacromial Impingement Syndrome. J Manipulative Physiol Ther 2020; 43:57-67. [DOI: 10.1016/j.jmpt.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 01/29/2023]
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Strength and Range of Motion in the Contralateral Side to Pain and Pain-Free Regions in Unilateral Chronic Nonspecific Neck Pain Patients. Am J Phys Med Rehabil 2019; 99:133-141. [PMID: 31464752 DOI: 10.1097/phm.0000000000001298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Rosa DP, Borstad JD, Ferreira JK, Camargo PR. The Influence of Glenohumeral Joint Posterior Capsule Tightness and Impingement Symptoms on Shoulder Impairments and Kinematics. Phys Ther 2019; 99:870-881. [PMID: 30921461 DOI: 10.1093/ptj/pzz052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. OBJECTIVE The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. DESIGN The design was a cross-sectional group comparison. METHODS Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. RESULTS The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°-8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53-2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°-28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15-185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41-55.63). LIMITATIONS These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. CONCLUSIONS Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.
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Affiliation(s)
- Dayana P Rosa
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - John D Borstad
- Department of Physical Therapy, The College of St Scholastica, Duluth, Minnesota
| | - Julia K Ferreira
- Department of Physical Therapy, Universidade Federal de São Carlos
| | - Paula R Camargo
- Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, 13565-905 São Carlos, São Paulo, Brazil
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Rozenfeld E, Finestone AS, Moran U, Damri E, Kalichman L. The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients. J Bodyw Mov Ther 2019; 24:31-38. [PMID: 31987560 DOI: 10.1016/j.jbmt.2019.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anterior knee pain (AKP) is a widespread problem among young athletes and soldiers. There are many theories on the etiology of AKP but there is little reference to myofascial trigger points (MTrPs) as a possible contributor. AIM To evaluate the association between AKP and prevalence of active and latent MTrPs in the hip and thigh muscles in soldiers. METHODS A cross-sectional study was conducted in the Beer-Sheva military outpatient physical therapy clinic. Subjects were 42 men and 23 women referred for physical therapy, 33 with a diagnosis of AKP (cases) and 32 with upper limb complaints (without AKP, controls). All subjects underwent physical evaluation by an examiner blinded to their identity and medical condition. The following muscles were assessed bilaterally for active or latent MTrPs: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal). RESULTS In six out of eight areas, the cases had a higher prevalence of total active and latent MTrPs than the controls. When summarizing MTrPs by muscle, cases had significantly more MTrPs than controls in each muscle. The largest difference was found in vastus medialis and vastus lateralis; nearly half of the cases had MTrPs in these muscles. CONCLUSIONS Subjects with AKP have a greater prevalence of MTrPs in their hip and thigh muscles than controls, indicating an association between MTrPs and AKP. Further research is necessary to determine whether MTrPs are the cause or the consequence of AKP.
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Affiliation(s)
- Evgeni Rozenfeld
- Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Aharon S Finestone
- Assaf HaRofeh Medical Center, Zeriffin, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Uria Moran
- Israel Defense Force, Medical Corps, Israel
| | - Elad Damri
- Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Pecos-Martin D, Ponce-Castro MJ, Jiménez-Rejano JJ, Nunez-Nagy S, Calvo-Lobo C, Gallego-Izquierdo T. Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial. Acupunct Med 2019; 37:141-150. [PMID: 31060367 DOI: 10.1136/acupmed-2018-011738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae. METHODS In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T30s; n=17), 60s (T60s; n=22) or 90s (T90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment. RESULTS Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta2=0.103), comparing T60s versus T30s (P=0.009; Cohen's d=1.044) and T90s versus T30s groups (P=0.001; Cohen's d=1.253), and for left side bending strength (P=0.043; partial Eta2=0.105), comparing T90s versus T30s (P=0.023; Cohen's d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05). CONCLUSIONS The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term. TRIAL REGISTRATION NUMBER NCT03006822.
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Affiliation(s)
- Daniel Pecos-Martin
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
| | - Manuel José Ponce-Castro
- 2 Faculty of Physical Therapy, Nursing and Podiatry, University of Sevilla, Sevilla, Sevilla, Spain
| | | | - Susana Nunez-Nagy
- 4 Physiotherapy and Nursing Departament, Alcalá University, Alcalá de Henares, Spain
| | - César Calvo-Lobo
- 5 Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, Spain
| | - Tomás Gallego-Izquierdo
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
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Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer - A case control study. Musculoskelet Sci Pract 2019; 40:72-79. [PMID: 30711913 DOI: 10.1016/j.msksp.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are no conclusive results concerning changes in scapular kinematics associated with upper limb dysfunctions after breast cancer surgery. OBJECTIVE To compare the three-dimensional (3-D) scapular kinematics during elevation of the arm between women after breast cancer surgery and controls. Shoulder range of motion (ROM), muscle strength, pain intensity, upper limb function, and quality of life were also assessed. METHODS Forty-two women were assigned to two groups (surgery group, n = 21; control group, n = 21). 3-D scapular kinematics was collected during elevation of the arm in the scapular plane. ROM was assessed using a digital inclinometer, muscle strength using a manual dynamometer, pain with the Visual Analogue Scale (VAS), upper limb function with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality of life with the 36-item Short-Form Health Survey (SF36). RESULTS The surgery group presented decreased scapular upward rotation at 120° of arm elevation in the scapular plane (p < .05; d = -0.88), decreased shoulder external rotation ROM and strength of shoulder abduction and external rotation when the affected side was compared to the non-affected side and control group. Moreover, the surgery group also reported higher pain, increased upper limb disability and poorer quality of life compared with healthy controls. CONCLUSION Scapular upward rotation seems to be decreased at 120° of arm elevation in women following breast cancer surgery. In addition, shoulder external rotation ROM, abduction strength, external rotation strength, function, and quality of life are also impaired in these women. They also experienced pain during the studied movements.
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Haik MN, Evans K, Smith A, Henríquez L, Bisset L. People with musculoskeletal shoulder pain demonstrate no signs of altered pain processing. Musculoskelet Sci Pract 2019; 39:32-38. [PMID: 30471479 DOI: 10.1016/j.msksp.2018.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Central sensitisation may contribute to persistent musculoskeletal shoulder pain. Few studies have provided a comprehensive sensory and psychosocial evaluation of this population. OBJECTIVE To comprehensively assess whether sensory function and psychosocial aspects are impaired in people with shoulder pain and whether age, gender and clinical outcomes are related to impaired sensory function. STUDY DESIGN Observational case-control study. METHODS Twenty-three participants with musculoskeletal shoulder pain and 23 age- and gender-matched healthy participants were included. Static (pressure and thermal pain thresholds) and dynamic (temporal summation) quantitative sensory testing was performed bilaterally at the shoulder and remote tibialis anterior muscle. Conditioned pain modulation was measured at the affected/matched shoulder. Shoulder function (SPADI), depression, anxiety and stress (DASS-21) and health-related quality of life (EQ-5D-5L) were also measured. Comparisons were performed between body regions and groups. Age and gender were included as factors in analyses. Clinical outcomes were tested for correlation with sensory measures. RESULTS Shoulder pain group had higher local pressure pain threshold (i.e., hypoalgesia; p = 0.03; Z = 0-5.04), higher SPADI score (p < 0.01; Z = -5.76) and higher EQ-5D-5L (p < 0.01; Z = 5.23) compared to the control group. There was no difference between groups for thermal pain sensitivity, dynamic sensory testing or psychological measures. CONCLUSION People with shoulder pain demonstrated mechanical hypoalgesia, increased upper limb disability and poorer quality of life compared with healthy controls. Central sensitisation seems not be a characteristic of musculoskeletal shoulder pain although it could be present in a subgroup of patients.
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Affiliation(s)
- Melina N Haik
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Kerrie Evans
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Ashley Smith
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
| | - Luis Henríquez
- School of Physical Therapy, Faculty of Health Sciences, San Sebastian University, Santiago, Chile.
| | - Leanne Bisset
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
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Habechian FAP, Lozana AL, Cools AM, Camargo PR. Swimming Practice and Scapular Kinematics, Scapulothoracic Muscle Activity, and the Pressure-Pain Threshold in Young Swimmers. J Athl Train 2019; 53:1056-1062. [PMID: 30615492 DOI: 10.4085/1062-6050-100-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Whereas alterations in scapular kinematics, scapulothoracic muscle activity, and pain sensitivity have been described in adult swimmers, no researchers have examined these outcomes in young swimmers. OBJECTIVES To compare scapular kinematics, scapulothoracic muscle activation, and the pressure-pain threshold (PPT) of the shoulder muscles among young nonpractitioners (those who were not involved in sports involving the upper limbs), amateur swimmers, and competitive swimmers. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 90 individuals (age = 11.63 ± 0.61 years) in 3 groups: nonpractitioners, amateur swimmers, and competitive swimmers. INTERVENTION(S) Scapular kinematics and activity of the upper trapezius, lower trapezius, and serratus anterior (SA) were measured during upper extremity elevation in the scapular plane. The PPT was assessed in the upper trapezius, infraspinatus, supraspinatus, middle deltoid, and tibialis anterior. MAIN OUTCOME MEASURE(S) Scapular kinematics, scapulothoracic muscle activation, and PPT. We conducted a 2-way mixed-model analysis of variance and a 1-way analysis of variance for scapular rotation and PPT, respectively. A Kruskal-Wallis test was used to assess muscle activity. The α level was set at .05. RESULTS Competitive swimmers presented more internal rotation at 90° ( P = .03) and 120° ( P = .047) and more anterior tilt at 90° ( P = .03) than nonpractitioners. Amateur swimmers demonstrated more anterior tilt at 90° ( P = .004) and 120° ( P = .005) than nonpractitioners. Competitive swimmers had greater SA activation in the intervals from 60° to 90° ( P = .02) and 90° to 120° ( P = .01) than amateur swimmers. They also displayed more SA activation in the interval from 90° to 120° than nonpractitioners ( P = .04). No differences were found in any of the muscles for the PPT ( P > .05). CONCLUSIONS Young competitive swimmers presented alterations in scapular kinematics and scapulothoracic muscle activation during upper extremity elevation that may be due to sport practice. Mechanical pain sensitivity was not altered in young swimmers.
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Affiliation(s)
- Fernanda A P Habechian
- Department of Physical Therapy, Universidade Federal de São Carlos, Brazil.,Departamento de Kinesiología, Universidad Católica del Maule, Talca, Chile
| | - Ana Letícia Lozana
- Department of Physical Therapy, Universidade Federal de São Carlos, Brazil
| | - Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium
| | - Paula R Camargo
- Department of Physical Therapy, Universidade Federal de São Carlos, Brazil
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Fernández-de-Las-Peñas C, Dommerholt J. International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. PAIN MEDICINE 2019; 19:142-150. [PMID: 29025044 DOI: 10.1093/pm/pnx207] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective There is no consensus on the essential diagnostic criteria for diagnosing a trigger point (TrP). In fact, a variety of diagnostic criteria are currently being used. Our aim was to conduct a Delphi panel to achieve an international consensus on the cluster of criteria needed for the TrP diagnosis to reach a consensus on the definition of active and latent TrPs and to clarify different clinical considerations about TrPs. Methods Following international guidelines, an international three-round Delphi survey was conducted. Questions were created based on a systematic literature search of the diagnostic criteria for TrPs. Results Sixty experts from 12 countries completed all rounds of the survey. A cluster of three diagnostic criteria was proposed as essential for the TrP diagnosis: a taut band, a hypersensitive spot, and referred pain. Eighty percent of the experts agreed that the referred pain elicited by a TrP can include different sensory sensations and not just pain, that is, pain spreading to a distant area, deep pain, dull ache, tingling, or burning pain. Eighty-four percent of the international experts consistently answered that the main clinical differences between active and latent TrPs are the reproduction of any of the symptoms experienced by a patient and the recognition of pain. No specific location of the pain referral area and TrP location should be expected. Conclusions This Delphi panel has produced an expert-based standardized definition of a TrP with a discussion of the clinical components, including the definition of referred pain and the difference between active and latent TrPs, thereby providing a foundation for future research in MPS.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jan Dommerholt
- Myopain Seminars, LLC, Bethesda Physiocare Inc., Bethesda, Maryland, USA.,Universidad CEU Cardenal Herrera, Valencia, Spain
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Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:1730-1739. [DOI: 10.1016/j.apmr.2018.04.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/09/2018] [Accepted: 04/18/2018] [Indexed: 11/20/2022]
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