Regular ArticleShoulder disorders: a state-of-the-art review
Abstract
This paper provides an up-to-date overview of the occurrence, diagnosis, risk factors, prognostic indicators and outcome of shoulder disorder (SD), and of the validity and reproducibility of diagnostic classifications and diagnostic imaging techniques for SD. Furthermore, the available evidence on the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and physiotherapy for SD is summarized on the basis of randomized controlled trials with an acceptable quality of their methods. The annual incidence of SD is estimated at about 7%, its 1-year period prevalence at about 51% and its lifetime prevalence at about 10%. While approximately 50% of all patients with SD seek medical care, about 95% are treated in primary health care. Of all new episodes of SD presenting to primary care, approximately 50% seem to resolve within 6 months, while about 40% seem to persist for up to 12 months. Several prognostic indicators for a favourable or a poor outcome of SD have been identified, but a comprehensive prognostic model is not available. While evidence for the prognostic validity of popular diagnostic classifications of SD is lacking, their reproducibility has been shown to be poor. The accuracy and clinical usefulness of diagnostic imaging techniques appear to be sufficiently verified for SD in secondary care, while their clinical usefulness in primary care and prognostic validity are not. NSAIDs and steroid injections for SD have been shown to be effective within 6 weeks, but their effect on long-term outcome remains unclear. There is very limited evidence for the effectiveness in SD of physiotherapy, including exercise therapy, ultrasound, electrotherapy, laser, mobilization and manipulation.
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A cross-sectional observational study comparing individuals with a symptomatic full-thickness rotator cuff tear with age-matched controls
2024, JSES InternationalA full-thickness rotator cuff tear (FTRCT) is defined as a complete tear of one of the four rotator cuff muscle tendons (supraspinatus, infraspinatus, subscapularis or teres minor). This condition can lead to pain and reduced function. However, not all FTRCT are symptomatic. A better understanding of the characteristics that lead some individuals with FTRCT to experience pain is fundamental to improve strategies used to manage this condition. This level II descriptive study aimed to explore potential sociodemographic, anatomical, psychosocial, pain sensitivity, biomechanical and neuromuscular variables that may differ between individuals with symptomatic FTRCT and age-matched individuals with asymptomatic shoulders.
In this cross-sectional observational study, adults aged 50 to 80 years of age, either with symptomatic FTRCT or no shoulder pain, were recruited via convenience sampling. Participants filled out questionnaires on sociodemographic and psychosocial variables. Then, various tests were performed, including pain pressure threshold, shoulder range of motion, shoulder muscle strength, shoulder ultrasound and radiologic examination, and sensorimotor functions testing. Each variable was compared between groups using univariate analyses (independent t-tests, Mann-Whitney U tests, exact probability Fisher tests). Significance was set at 0.05.
FTRCT (n = 30) and Control (n = 30) groups were comparable in terms of sex, age, and number of comorbidities. The symptomatic FTRCT group showed a higher proportion of smokers (P = .026) and more participants indicated consuming alcohol or drugs more than they meant to (P = .010). The FTRCT group had a significantly higher prevalence of glenohumeral osteophytes (48% vs. 17%; P = .012). Participants in the FTRCT group were significantly more stressed (P = .04), anxious (P = .003) and depressed (P = .002). The FTRCT group also showed significantly higher levels of pain catastrophisation (P < .001) and sleep disturbance (P < .001). The FTRCT group showed significantly lower range of motion for flexion (P < .001), and external rotation at 0° (P < .001) and 90° (P < .001) of abduction. Isometric strength in both abduction and external rotation were weaker (P = .005) for the FTRCT group.
Sociodemographic, anatomical, psychosocial and biomechanical variables showed statistically significant differences between the FTRCT and Control groups.
Shoulder disorders impair the ability to work. In most cases, the primary symptoms caused by shoulder disorders consist of pain and limitations in the range of motion.
This study aimed to investigate the efficacy of motion style acupuncture treatment (MSAT), a conservative treatment modality for shoulder disorders.
prospective observational study
A Korean Medicine hospital
Eighty outpatients with shoulder disorders
Either MSAT with integrative Korean medicine treatment (MSAT group; n = 40) or integrative Korean medicine treatment only (control group; n = 40).
The primary outcome was the shoulder range of motion (ROM), and the secondary outcomes were the numeric rating scale (NRS), visual analog scale (VAS), shoulder pain and disability index (SPADI), and 5-level EuroQol 5-dimension (EQ-5D-5L) scores.
At the primary endpoint (2 weeks from the start of the treatment), the MSAT group showed statistically significantly larger ROM for all motions, except adduction ROM, compared to the control group [Flexion ROM (165.10±4.14 vs. 150.49±4.06; P<0.001), extension ROM (43.24±1.55 vs. 40.56±1.51; P<0.05), abduction ROM (160.92±5.68 vs. 134.95±5.54; P<0.001), internal rotation ROM (73.38±2.96 vs. 65.00±2.89; P<0.001), and external rotation ROM (73.78±3.61 vs. 65.88±3.50; P<0.01)]. Additionally, the MSAT group showed significantly lower NRS, SPADI scores at week 2 than the control group; this trend was maintained until the 3-month follow-up.
Reproducibility of Exercise Interventions in Randomized Controlled Trials for the Treatment of Rotator Cuff-Related Shoulder Pain: A Systematic Review
2023, Archives of Physical Medicine and RehabilitationTo determine the reproducibility of exercise therapy interventions in randomized controlled trials for rotator cuff-related shoulder pain (RCRSP).
Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and SPORTDiscus from studies published from database inception to April 23, 2022.
Randomized controlled trials studying the use of exercise therapy for RCRSP.
Two reviewers extracted exercise reporting details from all studies using the Template for Intervention Description and Replication (TIDieR) and the modified Consensus on Exercise Reporting Template (CERT). The same 2 reviewers assessed risk of bias of all studies using Cochrane Risk of Bias Tool version 2.0.
For 104 studies meeting inclusion criteria, the average number of items reported on the TIDieR was 5.27 (SD 2.50, range 1-12 out of 12) and 5.09 (SD 4.01, range 0-16 out of 16) on the CERT. Improved reporting over time was seen on both the TIDieR and CERT dating back to 1993 and through April 23, 2022. When comparing groups of studies published before and after the TIDieR (2014) and CERT (2016) were established, a statistically significant increase in median scores was noted on the TIDieR (P=.02) but not the CERT (P=.31). Quality of exercise therapy reporting was highest in studies with “low risk” of bias, and lowest in studies with “high risk” of bias on the RoB-2.
Overall exercise reporting in trials for RCRSP is incomplete despite the development of the TIDieR and CERT checklists. This has implications for translating evidence into practice.
Effectiveness of Home-Based Exercise for Nonspecific Shoulder Pain: A Systematic Review and Meta-analysis
2022, Archives of Physical Medicine and RehabilitationTo evaluate the effectiveness of home-based exercise to treat nonspecific shoulder pain (NSSP).
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Controlled Register of Trials, and Physiotherapy Evidence Database were searched from inception to January 2022.
Independent reviewers selected randomized controlled trials that compared the effects of home-based exercise alone with no treatment or other conservative treatments in individuals with nonsurgical painful shoulder disorders. The primary outcomes were shoulder pain intensity and function, and the secondary outcome was shoulder range of motion (ROM).
Two reviewers independently conducted data extraction. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and the overall quality of the evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation approach.
Twelve studies were included in the review, and 10 studies were included in the meta-analysis. Low to moderate quality of evidence indicated that home-based exercise alone and other conservative treatments showed equal improvements in pain intensity reduction (mean difference [MD], 0.27; 95% confidence interval [CI], −0.12 to 0.65; I2=30%), function (standardized mean difference [SMD], 0.12; 95% CI, −0.14 to 0.38; I2=16%), flexion ROM (MD, 4.61; 95% CI, −1.16 to 10.38; I2=54%), and abduction ROM (MD, 3.74; 95% CI, −12.44 to 19.93; I2=82%). Very low quality of evidence indicated that home-based exercise alone was more effective than no treatment for pain intensity reduction (MD, −1.47; 95% CI, −2.33 to -0.61) and function improvement (SMD, −0.81; 95% CI, −1.31 to -0.31; large effect).
Home-based exercise alone may be equally effective as other conservative treatments and superior to no treatment for the treatment of NSSP. To draw firmer conclusions, further research is required to validate these findings.
Exercise before and after orthopedic surgery
2022, Exercise to Prevent and Manage Chronic Disease Across the LifespanExercise rehabilitation is a core part of the recovery from orthopedic surgeries of all kinds. However, in recent times the value of “prehabilitation,” in which patients undergo strength and conditioning, as well as aerobic exercise prior to an operation is becoming more commonplace. In this chapter, exercise considerations for a range of the most common orthopedic surgeries are presented, with recommendations made for prescribers.
Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial
2021, Journal of PhysiotherapyWhat are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain?
Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis.
A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region.
Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks.
The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant’s perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers.
There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE −2 (95% CI −9 to 5), GE minus HE −2 (95% CI −9 to 5) and HE minus IE 1 (95% CI −6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens’ effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups.
In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs.
ClinicalTrials.gov: NCT03055117