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PubMed1996

Intertester reliability of the cyriax evaluation in assessing patients with shoulder pain.

James Cyriax's approach to diagnosis and treatment of soft tissue disorders is frequently used by orthopaedic and sport physical therapists. The reliability of using Cyriax's system to determine diagnostic categories, however, has not been established. The purpose of this study was to examine the intertherapist reliability of assessments made using Cyriax's shoulder evaluation. Twenty-one cases of painful shoulder were evaluated independently by two experienced physical therapists. Therapists used a checklist to indicate their assessment of each case by selecting a specific shoulder lesion or by indicating that the case did not fit the Cyriax model. Cohen's kappa statistic was used to measure intertherapist agreement. Therapists classified 19 of the 21 cases into the same diagnostic category for a percent agreement of 90.5%. The kappa value was .875, indicating "almost perfect" agreement. Both therapists classified the same four cases of painful shoulder as not fitting the Cyriax model of soft tissue examination. The results of this study show that the Cyriax evaluation can be a highly reliable schema for assessing patients with shoulder pain.

Adult↗
PubMed1998

The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome.

Primary shoulder impingement syndrome is a common shoulder problem which, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after nine treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.

Female↗
PubMed2000

Construct validity of Cyriax's selective tension examination: association of end-feels with pain at the knee and shoulder.

STUDY DESIGN: Descriptive. OBJECTIVES: To examine the relationship between pain and normal and abnormal-pathologic end-feels during passive physiologic motion assessment at the knee and shoulder. We theorized that abnormal-pathologic end-feels would be more painful than normal end-feels. BACKGROUND: End-feel testing and pain intensity information are part of physical therapy musculoskeletal patient examinations. End-feels are categorized as normal or abnormal-pathologic. No previous studies have examined the relationship between pain during end-feel testing and the type of end-feel. METHODS AND MEASURES: Two physical therapists examined subjects with unilateral knee or shoulder pain. Each subject was examined twice. Passive physiologic motions, 2 at the knee and 5 at the shoulder, were tested by applying an overpressure at the end of range of motion using standardized positions. Subjects reported the amount of pain (0-10) immediately after the evaluator recorded the end-feel. Analyses included one-way ANOVAs and post-hoc Tukey's Honestly Significant Difference tests. RESULTS: Some abnormal-pathologic end-feels were significantly more painful than the normal end-feels at both the knee and the shoulder for all physiologic motions. Among the abnormal-pathologic end-feel categories there were no statistical differences in pain intensity, although small samples in some categories may be responsible for this finding. CONCLUSION: Abnormal-pathologic end-feels are associated with more pain than normal end-feels during passive physiologic motion testing at the knee or shoulder. Dysfunction should be suspected when abnormal-pathologic end-feels are present.

Adult↗
PubMed2006

Clinical trial of exercise for shoulder pain in chronic spinal injury.

BACKGROUND AND PURPOSE: The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. SUBJECTS: Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. METHODS: The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. RESULTS: Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. DISCUSSION AND CONCLUSION: A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.

Adult↗
PubMed1993

Headache and neck or shoulder pain--frequent and disabling complaints in the general population.

OBJECTIVE: to describe the prevalences of reported headache and neck or shoulder pain as unspecified complaints, and to explore the consequences of these complaints measured as unfitness for work. DESIGN: self-administered questionnaire as part of a general health screening. SETTING: all persons aged between 20 and 56 years, in the municipality of Tromsø were invited. Of 29,026 invited, 21,826 attended, and of these 20,026 answered the questionnaire. Some 17,700 answered the questions on headache, and 17,650 on neck or shoulder pain. RESULTS: 6.0% of the males reported weekly or more frequent headache, and 15.4% reported neck or shoulder pain. The corresponding prevalences in women were 13.1% and 24.9%. This female preponderance was present also among subjects expressing the complaints daily or monthly. The prevalences of reported neck or shoulder pain increased significantly with age, while the prevalences of reported headache were not influenced by age. Of the subjects with weekly headache, as many as 30% of both sexes reported being "seriously hampered or unable to perform ordinary work". CONCLUSIONS: many people in the general population live with disabling complaints, but the numbers seeking medical care for them are far fewer. It is important to demonstrate the high prevalence of headache and neck or shoulder pain, and also to understand the complexity of the causal factors, and the reason why only a proportion of sufferers seek professional help.

Adult↗
PubMed1975

The natural history of the frozen shoulder syndrome.

A prospective study has been made of 49 patients with the frozen shoulder syndrome (as distinct from tendinitis, calcific deposits and frozen shoulders occurring after coronary infarction or with pulmonary tuberculosis) of whom forty-one have been followed up for 5-10 years, always to their greatest recovery. There were three consecutive stages: pain, stiffness, and recovery. The stiffness stage was usually related to the duration of the recovery stage. The total duration was longer than is generally supposed (an average total of 30.1 months in contrast to about 18 months as often postulated). Generally speaking, the longer the stiffness stage is, the longer is the recovery stage. In 4 patients the second shoulder became similarly affected, 6 months to 7 years after the first, and followed a similar chronological sequence to the first. After greatest recovery, slight restriction of movement was found in more than half the cases, but in only 3, all of long duration, was the restriction a handicap. Arthrography, carried out on both shoulders in all patients during the recovery stage, showed in the affected shoulder fewer rotator cuff defects than expected at this age and fewer (four) than in the contralateral one (twenty-three); seemingly, the condition leads to the obliteration of some defects.

Adult↗
PubMed1975

Calcific tendinitis in the shoulder region.

Forty-three shoulders in 38 patients have been reviewed. They were all operated on for long-standing incapacitating calcific tendinitis in the region of the supraspinatus tendon. Excellent or good results were obtained in 34 out of 43 shoulders. The methods employed were simple incision and curettement in 12 shoulders, curettement combined with partial resection of the acromion in 26 shoulders, and resection of the acromion in 5 shoulders. The results were the same in these three groups and about 80 per cent of the operations were successful. The most commonly affected patients were women of 45-50 years of age.

Adult↗
PubMed1994

Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases.

32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were examined clinically and by special radiographs, dynamic sonography, MRI and arthroscopy. Typical complaints were pain during loading, especially during over the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement, but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly for identification of labral pathology, but arthroscopy appears necessary for a preoperative assessment.

Adolescent↗
PubMed1984

Treatment of peritendinitis calcarea of the shoulder by transcutaneous nerve stimulation.

Low-frequency transcutaneous nerve stimulation (TNS) is known to produce pain relief as well as widespread and prolonged increases in micro-circulation in the skin and other organs. Such stimulation has further been shown to eliminate skin calcium deposits in systemic sclerosis. The present study tested the effects of TNS on clinical symptoms in peritendinitis calcarea of the shoulder and the possibility that this procedure could eliminate calcium deposits in this disease. Ten patients with 14 calcareous shoulders received TNS-treatment with a follow-up time of 3-10 months. Two of these were classified as acute, 9 as chronic, and 3 as asymptomatic. Great relief of pain and of restricted mobility was encountered in 10 of the 11 symptomatic shoulders one week or two after the onset of daily stimulation with subsequent progressive improvement of residual complaints during the following weeks. There was one relapse after 2 months' freedom of pain. Calcium deposits persisted in the 3 asymptomatic shoulders, but was completely eliminated or greatly reduced in 7 of the 11 symptomatic ones. Comparison is made with reported untreated series. Even if most shoulders with calcified peritendinitis will spontaneously improve in time, TNS-treatment shortens the period of incapacitation and discomfort, secures freedom of pain, and allows earlier mobilization. It may thus represent an alternative method to other therapeutic procedures, such as roentgen irradiation and injection of anesthetics and hydrocortisone, in this disabling disorder.

Adult↗
PubMed1986

Bipolar implant shoulder arthroplasty.

A bipolar implant was designed by the author in 1975 for reconstruction of the severely arthritic shoulder. It has the advantage of not requiring glenoidal component fixation, but still provides an artificial joint interface. The ball of the humeral intramedullary stemmed component articulates with a polyethylene bearing within the glenoid cup component. This bipolar prosthesis was implanted in 15 shoulders of patients who presented severe arthritic shoulder disabilities. The follow up period averaged 41 months. Nine patients had rheumatoid arthritis, and five had osteoarthritis; all presented with severe pain and joint crepitation with loss of motion. A "shoulder score" system, based on the rating of pain, activities of daily living and range of motion, was devised to categorize the results obtained. Patients obtained greatly improved range of motion with good to excellent pain relief and very good functional restoration. Radiographically, the implant was well tolerated and there was no stem loosening. This procedure appears to be safe and efficacious for use in the severely arthritic shoulder.

Aged↗
PubMed2000

Early results of isoelastic hemiarthroplasty in chronic shoulder arthritis.

Fourteen isoelastic shoulder hemiarthroplasties were studied in patients with shoulder pain due to chronic rheumatoid arthritis and osteoarthritis unresponsive to conservative means. The average follow-up was 27 months (range: 12-46 months) and the average patient age was 66.4 years (range: 54-79 years). A Constant shoulder score was used to assess results. Pain relief was obtained in 85.7% of patients. Function scores averaged 8 preoperatively and 13 postoperatively. Subjectively, 12 patients improved. Average gain was 33 degrees of abduction, 35 degrees of flexion, and 21 degrees of external rotation. Internal rotation improved by two levels on the spine. Total shoulder scores improved from an average of 42 points preoperatively to 78 points postoperatively. There was 1 complication of immediate postoperative dislocation. Early results with isoelastic (polyacetyl resin) shoulder hemiarthroplasty are encouraging. The prosthesis is inexpensive and easy to use, requires minimal bone resection, involves cementless fixation, and has established results in tumor surgery. Its long-term value for chronic arthritis will be reported as part of an ongoing prospective study.

Aged↗
PubMed2000

Adhesive capsulitis of the shoulder in male cardiac surgery patients.

Two hundred fourteen consecutive male cardiac surgery patients were retrospectively evaluated for the incidence of adhesive capsulitis of the shoulder and were assessed for risk factors. Only male patients were included, as the study took place at a Veteran's hospital. Patients who had no shoulder problems prior to cardiac surgery and were experiencing shoulder pain or stiffness postoperatively underwent history, physical examination, and radiographic studies. Thirty-five patients who had shoulder complaints were identified and evaluated. A 3.3% incidence (seven patients) of adhesive capsulitis of the shoulder in a male post-cardiac surgery population was established.

Age Distribution↗
PubMedDate not supplied

The immediate and short-term effects of a wrist extension orthosis on upper-extremity kinematics and range of shoulder motion.

OBJECTIVE: The purpose of this study was to investigate upper-extremity kinematics and range of shoulder motion while wearing a wrist extension orthosis compared to the free hand at initial testing and after a week's wear. METHOD: A convenience sample of healthy women, ages 20-50 years, performed a stacking task and a pouring task, freehanded and splinted, at two times, 1 week apart in this counterbalanced, repeated measures design. A Motion Analysis 3-D system measured quality of movement and range of motion variables. A 2 by 2 analysis of variance (splinted vs. freehanded by time of testing) was used to analyze each variable. RESULTS: In both tasks, participants tended to move more slowly (p = 0.005) with less direct movements (p < .001) when wearing the orthosis. In stacking, splinted movements were also less smooth than when free-handed (p < .0001). When splinted both tasks required more shoulder abduction (p < .0001) and pouring required more shoulder flexion (p < .0001). Participants demonstrated several improvements in quality of movement and amount of shoulder motion used after a weeks' orthotic wear, indicating some adaptation to the orthosis with use. CONCLUSION: In this study, a wrist extension orthosis interfered with the quality of upper-extremity movement and required more range of shoulder movement compared to the free hand. Future research is needed to determine whether persons with upper-extremity conditions (i.e., arthritis, carpal tunnel syndrome) respond similarly to wrist orthoses. Therapists should consider discussing with patients how their wrist splint could affect their hand performance and help patients learn techniques to reduce stress on their proximal joints.

Adult↗
PubMed1993

Shoulder tendinitis and its relation to heavy manual work and exposure to vibration.

Three categories of construction industry workers (54 bricklayers, 55 rockblasters, and 98 foremen) were compared in a cross-sectional study. In a structured interview they reported exposure to loads lifted, vibration, and years of manual work. They were also subjected to a clinical investigation including medical history and a detailed shoulder examination. Among the rockblasters 33% had signs of tendinitis in the left and 40% in the right shoulder. Among the bricklayers and foremen 8-17% had signs of shoulder tendinitis. In a multiple logistic regression being a rockblaster compared with being a foreman showed an odds ratio (OR) of 3.33 for left-sided and 1.71 for right-sided shoulder tendinitis. Vibration exposure yielded an OR of 1.84 and 1.66 for the left and right sides, respectively. Vibration exposure or work as a rockblaster seemed to be risk indicators for tendinitis of the shoulders.

Adult↗
PubMed1978

Swelling of the upper extremity, function and muscle strength of shoulder joint following mastectomy combined with radiotherapy.

Swelling of the arm, mobility of the shoulder joint and muscle strength were examined in 76 patients with breast cancer 4.5 to 14 years (mean 8 years) after primary therapy. Marked arm swelling was found on the operated side in 31% of the patients operated by radical mastectomy and in 18% of those having undergone total mastectomy. The swelling was more marked in the upper arm than in the forearm. Patients irradiated postoperatively with a megavoltage technique showed more often and more oedema than those treated with a kilovoltage technique. Obese patients had more swelling than patients of normal weight. Of the various movements of the shoulder joint, abduction, adduction, flexion, extension, horizontal extension and internal rotation were significantly reduced on the operated side in comparison with the non-operated side, but the differences were not great. Neither swelling of the arm nor the patient's weight had any effect on the function of the shoulder joint, as expressed in terms of abduction. Of the muscle groups in the shoulder joint adductors, flexors and extensors were significantly weaker on the operated than on the non-operated side. The muscle strength of the operated side averaged 25% weaker than that of the control side. Swelling of the arm did not reduce the muscle strength of the shoulder joint.

Adult↗
PubMed2000

Familial osteoarthritis and Milwaukee shoulder associated with calcium pyrophosphate and apatite crystal deposition.

OBJECTIVE: To characterize and define the phenotypes observed in a large Italo-Argentinean kindred with osteoarthritis, chondrocalcinosis, and Milwaukee shoulder (MS). METHODS: Seventy-five members were evaluated with a history, examination, and radiographs of shoulders, spine, hands, and knees. Superior subluxation of the glenohumeral joint was graded using shoulder radiographs and tomography and nuclear magnetic resonance imaging and 3 dimensional computed tomography was performed on selected members. In 31 family members peripheral blood DNA was utilized for genetic linkage analysis of several candidate gene loci previously linked to chondrocalcinosis phenotypes, as well as those implicated in the proper patterning of skeletal elements and cartilage differentiation. In addition, direct sequence analysis of type II collagen gene (COL2A1), the gene that codes for the major structural protein of cartilage, was undertaken in 3 affected and 3 unaffected members of the family. RESULTS: MS was seen in one member of the first generation and 6 members of the 2nd generation, while 8 members of the 3rd generation showed an incomplete form of MS. Isolated superior subluxation of the shoulder was seen in 16 other family members of the 3rd and 4th generations. Osteoarthritis of the spine and peripheral joints was seen in 31 affected members, while chondrocalcinosis was observed in 6 members of the first generation. Shoulder synovial fluid from 2 patients showed the presence of both apatite and calcium pyrophosphate dihydrate crystals. Direct analysis of the COL2A1 gene indicated no known disease determining mutations in affected members, thus excluding this gene as a candidate gene in this family. Genetic linkage to several candidate loci, including the chondrocalcinosis loci on chromosomes 5p and 8q, as well as loci for HOX A and C were also excluded. Linkage analyses of other loci for the HOX B and D genes and the PAX 1 and 9 genes were uninformative in this kindred. CONCLUSION: This kindred illustrates an unusual type of osteoarthritis with secondary intraarticular and periarticular calcification and MS in the most severely affected elderly members. A search for linkage to some potential candidate genes was either excluded or uninformative. Further linkage analysis to identify potential candidate genes is in progress.

Adult↗
PubMed1999

Shoulder arthroplasty. Indications, contraindications and complications.

Prosthetic substitution of the glenohumeral joint, begun at the end of the last century, has developed greatly in recent years. Today the most widely used shoulder prostheses are defined as "modular" because of their extensive adaptability. The capacity to adapt to anatomic variations must be incorporated within their structure, and normal articular biomechanics must be respected. The choice of prosthesis must be based on the condition of the joint surfaces, on the anatomic and functional condition of the rotator cuff. So endoprosthesis of the shoulder is indicated for avascular necrosis of the head of the humerus, fractures and pseudoarthrosis of the extreme proximal end of the humerus, arthropathy following rotator cuff rupture. Total shoulder prosthetization is indicated for glenohumeral osteoarthritis, rheumatoid arthritis and outcomes of endoprosthesis. The principal contraindications for shoulder replacement include an infection in progress, Charcot's arthropathy and severe neurological pathologies. The complications of shoulder prostheses include infection, dislocation, loosening of a component, periprosthetic humeral and glenoid fractures, nerve injuries, fractures of a prosthetic component and ectopic ossification. At present prosthetic substitution of the glenohumeral joint offers good results. Indispensable conditions for these results include anatomic and functional integrity of the musculature, good bone quality, correct positioning of the prosthetic components and a proper rehabilitation program.

Arthroplasty, Replacement↗
PubMed2000

Thawing of frozen shoulder in menopausal women treated with a Japanese herbal medicine, Kanzo-to extract: report of two cases.

We report here two patients with frozen shoulder syndrome and severe menopausal symptoms. Short-term administration of Kanzo-to extract thawed the shoulders completely enough for the patients to move their cervical and shoulder joints without any restriction or pain. Their menopausal symptoms were cured simultaneously. Kanzo and Shakuyaku were found to have different effects on shoulder stiffness and disability in shoulder joints.

Humans↗