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PubMed2004

[Measurement of shoulder disability in the athlete: a systematic review].

OBJECTIVES: To identify all available shoulder disability questionnaires and to examine those that could be used for athlete. METHODS: We systematically reviewed the literature in Medline using the keywords shoulder, function, scale, index, score, questionnaire, disability, quality of life, assessment, and evaluation. We searched for scales used for athletes with the keywords scale name AND (sport OR athlete). Data were completed by using the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation" textbook. Analysis took into account the clinimetric quality of the instruments and the number of items specifically related to sports. RESULTS: A total of 37 instruments have been developed to measure disease-, shoulder-specific or upper extremity specific outcome. Older instruments were developed before the advent of modern measurement methods. They usually combined objective and subjective measures. Recent instruments were designed with use of more advanced methods. Most are self-administered questionnaires. Fourteen scales included items assessing sport activity. Four of these scales have been used to assess shoulder disability in athlete. Six scales have been used to assess such disability but do not have specific items related to sports. CONCLUSION: There is no gold standard for assessing shoulder outcome in the general population and no validated outcome instruments specifically for athletes. We suggest the use of ASES, WOSI and WORC scales for evaluating shoulder function in the recreational athletes. The DASH scale should be evaluated in this population. The principal criterion in evaluating shoulder function in the high level athlete is a return to the same level of sport performance. Further studies are required to identify measurement tools for shoulder disability that have a high predictive value for return to sport.

Athletic Injuries↗
PubMed2004

Benefits of an anatomical reconstruction of the humeral head during shoulder arthroplasty: a finite element analysis.

OBJECTIVE: To study the influence of the shape of the prosthetic humeral head on shoulder biomechanics and then to evaluate the benefits of an anatomical reconstruction of the humeral head after shoulder arthroplasty. DESIGN: A 3D numerical model of a healthy shoulder was reconstructed. The model included the proximal humerus, the scapula and, for stability purposes, the subscapularis, infraspinatus and supraspinatus rotator cuff muscles. BACKGROUND: Shoulder prostheses used nowadays, called third generation, allow for a better adaptation of the implant to the anatomy of the proximal humerus than previously used implants. However, no biomechanical study has shown the benefits of this anatomical reconstruction of the humeral head. METHODS: The model was used to compare the biomechanics of a shoulder without implant with the biomechanics of the same shoulder after humeral hemiarthroplasty. Two humeral components were tested: a second-generation prosthesis and an implant with an anatomically reconstructed humeral head. RESULTS: The anatomical reconstruction of the humeral head restored the physiological motions and limited eccentric loading of the glenoid. Conversely, the second-generation implant produced contact forces in the superior extremity of the glenoid surface leading to bone stresses up to 8 times higher than for the intact shoulder. CONCLUSIONS: This analysis provided insights into the mechanical effects of different reconstructions of the humeral head and highlighted the advantages of anatomical reconstructions of the humeral head during shoulder arthroplasty.

Arthroplasty, Replacement↗
PubMed2005

Tuberculosis of the shoulder joint.

OBJECTIVES: Skeletal tuberculosis is less common than the pulmonary form. The involvement of the shoulder joint is infrequent. We report our experience treating tuberculosis of the shoulder in 11 patients. METHODS: There were seven men and four women, ranging in age from 19 to 55 years (average 28.09 years). The duration of their complaints at presentation ranged from 3 to 24 months. The most common presentation was pain, which was seen in 10 joints. All of the patients had mild to moderate restriction of motion of the shoulder. On laboratory examination, the erythrocyte sedimentation rate was increased mildly. No patient had an active tuberculosis lesion or history of pulmonary disease. The diagnosis was based on the clinical picture and radiographic features, and was confirmed by open biopsy. The diagnosis was not confirmed by biopsy in one patient, but the family history and clinical and radiological features were highly suggestive of tuberculosis. Surgical debridement was done in two patients and open biopsy in eight patients in order to obtain samples for pathology. Arthrodesis was done in only one patient. In all patients, treatment began with a four-drug regimen for 2 months, followed by a two-drug regimen for 10 months. RESULTS: The mean follow-up period after the end of treatment was 28.72 months (range, 22-52 months). At the time of the last visit, all the lesions had healed without recurrence. Five cases had a painless, mobile shoulder, while three had mildly restricted shoulder motion without pain, and three had residual limitation of motion of the affected shoulder. CONCLUSIONS: Tuberculosis of the shoulder can be difficult to diagnose in the early stages. If not diagnosed early, bony tuberculosis may reduce the quality of life. Therefore, tuberculosis should be suspected in cases of long-standing pain in the shoulder. It is necessary to keep tuberculosis in the differential diagnosis of several osseous pathologies. Arthrodesis should be reserved only for lesions that fail to heal after adequate chemotherapy and rehabilitation.

Adult↗
PubMed2006

A 37-item shoulder functional status item pool had negligible differential item functioning.

OBJECTIVE: Measures of shoulder function may differ by dominance of affected shoulder, surgical history, gender, or race. We present a technique for determining whether observed differences in function between groups are due to biased test items or real differences in function. STUDY DESIGN AND SETTING: Four hundred patients who were receiving rehabilitation for a variety of shoulder impairments completed a survey of shoulder function. Thirty-seven items measuring shoulder function were analyzed for differential item functioning (DIF) related to demographic characteristics using an ordinal logistic regression (OLR) and item response theory (IRT) approach. When DIF was identified in an item, we modified the IRT analysis to calibrate item parameters separately in appropriate demographic groups. We compared adjusted and unadjusted patient ability measures in each demographic group. RESULTS: Several items were found to have a modest amount of DIF related to the different demographic characteristics, especially gender; however, adjusting measures for DIF had little impact on overall measures of shoulder function and made almost no difference in average shoulder function across demographic groups. CONCLUSION: In this pool of shoulder function items, adjustment for DIF made almost no difference in measures of function across demographic groups.

Activities of Daily Living↗
PubMedDate not supplied

The effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception.

The effect of glenohumeral arthritis and subsequent total shoulder arthroplasty (TSA) on shoulder proprioception has not been evaluated previously. A prospective analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken. Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA. The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested (flexion, abduction, and external rotation). There were significant differences (P < .05) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems. Six months after TSA, position sense was significantly improved (P < .05) and was not significantly different from that in the contralateral shoulder or the comparison group. Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side (P < .05). Six months after TSA, the sensitivity to detection of motion improved (P < .01) and was not significantly different than that in the uninvolved contralateral shoulder. In addition, the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group. This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis. After TSA, there was a marked improvement in proprioception.

Aged↗
PubMedDate not supplied

Patient functional self-assessment in late glenoid component failure at three to eleven years after total shoulder arthroplasty.

Failure of the glenoid component is the most common indication for late revision of a total shoulder arthroplasty (TSA). This is the first study to characterize the deterioration in patient self-assessment of shoulder function occurring with glenoid component failure at times remote from the index surgery. Of 115 total shoulders, 11 had revision by the original surgeon for isolated glenoid loosening. Simple Shoulder Test scores averaged 4.4 before TSA, rose to a mean of 11.3 after surgery, and fell to a mean of 4.6 before revision for glenoid loosening performed at a mean of 7 years after TSA. All shoulders showed a drop of at least 3 points between the peak Simple Shoulder Test score and the prerevision Simple Shoulder Test score. Periodic self-assessment of shoulder function may offer a method of screening patients for the possibility of late glenoid component failure.

Adult↗
PubMedDate not supplied

A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up.

The purpose of our study was to evaluate the long-term outcomes of patients with multidirectional instability of the shoulder initially treated with rehabilitation exercises. Sixty-four patients were treated for atraumatic multidirectional instability of the shoulder between 1987 and 1990. Preliminary evaluation was performed 2 years after initiation of treatment, and final evaluation of the patients was performed at a mean of 8 years after initiation of treatment. At the preliminary evaluation, 5 patients were lost to follow-up. Of the remaining 59 patients, 20 had undergone surgical treatment for stabilization of their shoulder. Of the 39 nonsurgically treated patients, 19 continued to have significant pain, and 18 continued to have significant instability of their shoulder. Of the 59 patients, 28 subjectively rated their shoulder condition as better or much better after conservative treatment. At the final evaluation, 2 more patients were lost to follow-up, and 1 additional patient had had surgical treatment. Thus, of the 57 patients available for final follow-up, 36 had received nonsurgical care, and 21 had undergone surgical treatment. Of the 36 nonsurgically treated patients, 23 rated their shoulders as good or excellent with regard to pain, and 17 were good or excellent with regard to instability. By the modified Rowe grading scale, 5 of 36 patients had excellent results, and 12 had good results. The remaining 19 patients were rated as having poor results. Only 8 patients reported that their shoulders were free of all pain and instability. Overall, of the entire group of 57 patients evaluated between 7 and 10 years after initiation of care, 17 had a satisfactory outcome from nonsurgical management based on stability and Rowe scores, 23 had good or excellent results with regard to pain, and 20 subjectively rated their shoulders as good or excellent. This review revealed a relatively poor response to nonsurgical treatment of multidirectional instability in this population of young, athletic patients.

Adolescent↗
PubMedDate not supplied

Rotator cuff repair after shoulder replacement.

Development of a rotator cuff tear after shoulder arthroplasty can adversely affect outcome. To assess the results of a subsequent procedure to repair the torn cuff, we reviewed all shoulder arthroplasties performed at our institution to identify patients who had a subsequent operation for cuff repair with or without component revision. We identified 19 patients and 20 involved shoulders. One patient was lost to follow-up, and one was excluded because the subsequent cuff repair could not be adequately accomplished. Patients were studied retrospectively a mean of 9.1 years after cuff repair by analysis of prospectively collected data supplemented by use of a questionnaire (10 shoulders). The presence of the tear was diagnosed preoperatively by physical examination or routine radiographs in 13 shoulders, an arthrogram in 3, and surgical exploration in 2. The tear involved the subscapularis in 7 shoulders, the supraspinatus in 15, and the infraspinatus in 8. Rotator cuff repair was successful in only 4 shoulders and was unsuccessful in the remaining 14. Pain was absent in 4 shoulders, slight in 6, occasionally moderate in 5, and moderate in 3. The mean visual analog pain score was 5.6. Range of motion was limited, with mean values for elevation of 78 degrees and external rotation of 54 degrees . Because results of subsequent cuff repair are poor, every attempt should be made to repair the cuff securely and carefully direct postoperative physical therapy.

Aged↗
PubMed2006

Relationships between throwing mechanics and shoulder distraction in collegiate baseball pitchers.

A distraction force occurs at the shoulder joint in all throwing motions. At the professional level, the relationship between this force and pitching mechanics has been explained. Three-dimensional, high-speed (240 Hz) video data were collected on fastballs from 48 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing arm elbow and shoulder joints were calculated. Multiple linear regression analysis was used to investigate the relationships between shoulder distraction and pitching mechanics. Shoulder distraction stress averaged 81% body weight for the collegiate pitchers. The mean ball velocity was 81 mph. Ten parameters of pitching mechanics accounted for 89% of the variance in shoulder distraction. Two of the variables (maximum shoulder abduction torque and elbow angle at release) previously shown to affect shoulder distraction in professional baseball pitchers appear to be important for collegiate pitchers as well. These data provide a scientific basis for clinicians, athletes, and coaches to establish methods to reduce distraction force at the shoulder joint through modification of pitching mechanics.

Adult↗
PubMed1998

Objective definition of shoulder dystocia: a prospective evaluation.

OBJECTIVE: The current study was undertaken to validate the objective definition of shoulder dystocia in a prospectively evaluated group of patients. STUDY DESIGN: Selected vaginal deliveries from January 1995 to December 1996 (N = 722) were evaluated for head-to-body delivery time and use of ancillary obstetric maneuvers. Charts were reviewed for perinatal and outcome data. RESULTS: Ninety-nine deliveries were complicated by shoulder dystocia and 623 deliveries had no shoulder dystocia. The objective definition described infants with lower 1-minute Apgar scores and increased birth weight. All fetal injuries were in the shoulder dystocia group. Duration of the second stage was significantly associated with a diagnosis of shoulder dystocia. The risk of shoulder dystocia was increased with maternal diabetes, but it was not correlated with birth weight in diabetics. CONCLUSIONS: The objective definition of shoulder dystocia identified a group of patients with an increased birth weight and risk of fetal injuries. The use of an objective definition will assist the evaluation of prophylactic and treatment proposals for shoulder dystocia.

Adult↗
PubMed2001

Prepregnancy body mass index in non-diabetic women with and without shoulder dystocia.

OBJECTIVE: To investigate the distribution of prepregnancy body mass index (BMI) in non-diabetic women with and without shoulder dystocia. STUDY DESIGN: Cases were 142 non-diabetic women experiencing shoulder dystocia during the period from 1 January 1993 to 31 December 1999. Shoulder dystocia was defined as the impossibility of delivering the fetal shoulders by standard procedures. Controls were 142 women vaginally delivering during the same period without experiencing shoulder dystocia. Cases and controls were matched for parity (primi-/multipara) and birthweight (+/-250 g). Women with diabetes mellitus, gestational diabetes or a history of shoulder dystocia in a previous birth were excluded. The BMI and selected obstetric data were extracted from an internal database in the department. RESULTS: Delivery was performed using McRoberts maneuvre (42%), Woods screw (50%) or by primary delivery of the posterior arm (8%). Women experiencing shoulder dystocia had significantly more labor augmentation and more instrumental deliveries. No differences were shown in the prevalence of low Apgarscores. The proportion of children with Erbs palsy and clavicular fracture was very close to be significantly different in cases or controls. However, these data does not allow any conclusion. The distribution of BMI was equal in cases and controls. CONCLUSION: Non-diabetic women experiencing shoulder dystocia do not have a higher BMI than non-diabetic women delivering without this experience, given a fixed fetal weight.

Birth Weight↗
PubMed2000

Heterotopic ossification after total shoulder arthroplasty.

Fifty-eight primary ingrowth total shoulder arthroplasties, performed between 1989 and 1992, with a minimum of 2 years' radiographic and clinical follow-up (mean, 4.7 years), were reviewed to determine the frequency and clinical significance of heterotopic ossification after total shoulder arthroplasty. Fourteen of the 58 shoulders had radiographic evidence of heterotopic ossification: grade I (12 shoulders) and grade II (2 shoulders). Heterotopic ossification was present on the early postoperative radiographs (1-2 months) in 12 of the 14 shoulders. Among these 12 shoulders, there was no increase in the grade of ossification comparing the early postoperative radiographs with those obtained at a minimum of 2 years. There were no identifiable preoperative patient characteristics associated with the development of heterotopic ossification (P > .05). Range of motion, pain, and result rating were not statistically different comparing patients with and without heterotopic ossification (P > .05). The data from this study suggest that when heterotopic ossification develops after elective total shoulder arthroplasty, it is usually low grade, is present in the early postoperative period, is nonprogressive, and does not adversely affect the clinical results.

Arthroplasty, Replacement↗
PubMed1989

Heterotopic bone formation following total shoulder arthroplasty.

The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare.

Adult↗
PubMedDate not supplied

Relation between the painful shoulder and the cervical spine with narrow canal in patients without obvious radiculopathy.

It is well known that cervical radiculopathy sometimes causes shoulder pain. Hypothesizing that the cause of painful shoulder is related to the cervical spine in the absence of obvious radiculopathy, we measured the anteroposterior diameter of the spinal canal and the range of motion of the cervical spine in patients with painful shoulder on lateral cervical radiographs of the spine. Painful shoulder was diagnosed in 76 patients (24 men and 52 women; mean age 57.6 years). Patients who reported neck pain or numbness of the upper limbs and patients with neurologic abnormalities were excluded from this study. A control group of 54 asymptomatic volunteers (27 men and 27 women; mean age 55.5 years) was formed. The difference in age between the patient group and the control group was not significant. The anteroposterior diameter of the spinal canal at C5 and C6 in the painful-shoulder group (C5: 12.74 mm; C6: 12.76 mm) was significantly narrower than in the control group (C5: 13.60 mm; C6: 13.79 mm). The range of motion was greatest at C4-5 and smallest at C2-3 in both groups; and there was no significant difference in the range of motion between the painful-shoulder group and the control group. When women only or men only were assessed, the results were nearly the same between groups. The cervical spine without obvious radiculopathy appears to be involved in patients with a painful shoulder. We speculate that the shoulder is affected by irritation of a cervical nerve root or referred pain.

Adult↗
PubMed2003

Suprascapular nerve block or a piroxicam patch for shoulder tip pain after day case laparoscopic surgery.

BACKGROUND AND OBJECTIVE: The reported incidence of shoulder tip pain following laparoscopic surgery varies from 35 to 63%. This study evaluated the analgesic efficacy of either performing a prophylactic suprascapular nerve block with bupivacaine or applying a piroxicam patch to the skin over both shoulders for the relief of shoulder tip pain after laparoscopy. METHODS: Sixty healthy informed female patients were randomly assigned to one of three groups: (a) a control group (n = 20), no treatment; (b) a suprascapular nerve block group (n = 20) in which a bilateral suprascapular nerve block was performed before induction of anaesthesia with 5 mL 0.5% bupivacaine with epinephrine; and (c) a piroxicam patch group (n = 20) in which a 48 mg piroxicam patch on the skin of each shoulder was applied before induction of anaesthesia. All patients received a total intravenous anaesthesia technique with propofol, fentanyl and vecuronium. Shoulder tip and wound pain were recorded on a visual analogue pain scale at five time intervals for 24 h after surgery. RESULTS: A total of 80% of patients in the control group, 75% in the suprascapular nerve block group and 45% in the piroxicam patch group complained of shoulder tip pain during the recording period (P < 0.05). The scores for shoulder tip pain in the piroxicam patch group were significantly lower compared with the control group at 3, 6 and 12 h, and compared with the suprascapular nerve block group at 6 and 12 h. The need for analgesics was also significantly lower in the piroxicam patch group compared with the other two groups. CONCLUSIONS: Prophylactic piroxicam patches are effective and safe for the relief of shoulder tip pain after laparoscopy. Bilateral suprascapular nerve block is not effective in this setting.

Administration, Cutaneous↗
PubMed1998

Shoulder and elbow motion during two speeds of wheelchair propulsion: a description using a local coordinate system.

Individuals who propel wheelchairs have a high prevalence of upper extremity injuries. To better understand the mechanism behind these injuries this study investigates the motion of the shoulder and elbow during wheelchair propulsion. The objectives of this study are: (1) To describe the motion occurring at the shoulder and elbow in anatomical terms during wheelchair propulsion; (2) to obtain variables that characterize shoulder and elbow motion and are statistically stable; (3) to determine how these variables change with speed. The participants in the study were a convenience sample of Paralympic athletes who use manual wheelchairs for mobility and have unimpaired arm function. Each subject propelled an ultralight wheelchair on a dynamometer at 1.3 and 2.2 meters per second (m/s). Biomechanical data was obtained using a force and moment sensing pushrim and a motion analysis system. The main outcome measures investigated were: maximum and minimum angles while in contact with the pushrim, range of motion during the entire stroke and peak accelerations. All of the measures were found to be stable at both speeds (Cronbach's alpha > 0.8). The following measures were found to differ with speed (data format: measure at 1.3 m/s +/- SD; measure at 2.2 m/s +/- SD): minimum shoulder abduction angle during propulsion (24.5 degrees +/- 6.7, 21.6 degrees +/- 7.2), range of motion during the entire stroke in elbow flexion/extension (54.0 degrees +/- 9.9, 58.1 degrees +/- 10.4) and shoulder sagittal flexion/extension (74.8 degrees +/- 9.4, 82.6 degrees +/- 8.5), and peak acceleration in shoulder sagittal flexion/extension (4044 degrees/s2 +/- 946, 7146 degrees/s2 +/- 1705), abduction/adduction (2678 degrees/s2 +/- 767, 4928 degrees/s2 +/- 1311), and elbow flexion/extension (9355 degrees/s2 +/- 4120, 12889 degrees/s2 +/- 5572). This study described the motion occurring at the shoulder and elbow using a local coordinate system. Stable parameters that characterize the propulsive stroke and differed with speed were found. In the future these same parameters may provide insight into the cause and prevention of shoulder and elbow injuries in manual wheelchair.

Adult↗
PubMed1998

Humerospinous distance measurements: accuracy and usefulness for predicting shoulder dystocia in delivery at term.

OBJECTIVE: To investigate if the humerospinous distance, as an indicator of shoulder width, could predict shoulder dystocia at term. DESIGN: Prospective cross-sectional study of a stratified reference group of healthy women and a test group of women with risk factors for shoulder dystocia. Measurements were not revealed. Outcome measures were difficulties with delivery of the shoulders and correlation with maternal body mass and birth weight. SUBJECTS: Seventy-two women with singleton pregnancies at a University Clinic: 32 women at 39-42 weeks for reference and 40 women in an at-risk test group (weight > 90 kg, weight gain > 20 kg, previous macrosomic baby, history of shoulder dystocia/difficult delivery, clinical suspicion of a large baby). Women with a breech fetus, twins and those not able to deliver vaginally were excluded. METHODS: Fetal shoulders were measured from the convergence of the cervical spinous processes at the approximate cervicothoracic vertebral junction to the medial border of the humeral head. Correlations were made with maternal body mass, birth weight, birth weight estimation, ultrasound and postnatal humerospinous measurements. RESULTS: One case of shoulder dystocia in a fetus with an average humerospinous measurement occurred in the reference group and there were no cases in the test group. There was no predictive value of a large humerospinous measurement and no correlation with maternal or fetal size. Movement of the fetal arm could change the humerospinous distance considerably, which could account for the difference between a normal and large measurement. CONCLUSION: The humerospinous distance cannot be used to predict shoulder dystocia.

Adult↗
PubMed2004

Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain.

OBJECTIVE: This study was conducted to estimate the incidence and clinical predictors of post-thoracotomy shoulder pain and to determine the effectiveness of thoracic epidural block in alleviating this pain. DESIGN: A prospective clinical trial. SETTING: University teaching hospital. PARTICIPANTS AND INTERVENTIONS: Thirty-two adult patients undergoing elective thoracic surgery consented to participate in the study. All operations were open thoracotomies done by the same team of surgeons and anesthesiologists. A thoracic (T6) epidural catheter was placed before induction of general anesthesia. Each patient received 7 mL of lidocaine 2% epidurally and repeated doses of 5 mL of lidocaine 2% every half hour during the operation. Postoperatively, the occurrence of incision or ipsilateral shoulder pain was observed and treated with a maximal dose of 5 mL of lidocaine 2%. If ineffective, indomethacin suppository (nonsteroidal anti-inflammatory drug [NSAID]) was given. Variables such as patient's age, sex, American Society of Anesthesiologists physical status, type, site and duration of surgery, duration of anesthesia, the resection of main bronchus, and the use of thoracostomy tubes were recorded. MEASUREMENTS AND MAIN RESULTS: Postoperatively, 10 patients (31%) had shoulder pain, 4 patients (12.5%) complained of incision pain, and 2 (6.3%) complained of both incision and shoulder pain. A bolus of 5 mL of lidocaine 2% in the epidural catheter relieved incision pain in all the patients, but was ineffective for shoulder pain. Indomethacin suppository was effective in these patients. No correlation was found between any variable and the occurrence of shoulder pain. CONCLUSIONS: It is concluded that post-thoracotomy shoulder pain is a common problem, and the previously mentioned variables did not predict its appearance. Thoracic epidural block is effective in the treatment of incision but not shoulder pain. The NSAID indomethacin suppository was found to be effective for that problem.

Analgesia, Epidural↗