Work-restricting musculoskeletal pain after bariatric surgery or usual obesity care in the Swedish Obese Subjects study.

OBJECTIVE: The objective of this study was to study the recovery from, and incidence of, work-restricting musculoskeletal pain after bariatric surgery compared with usual obesity care. METHODS: Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self-reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. RESULTS: Compared with matched controls, bariatric surgery was associated with better recovery from baseline work-restricting knee and ankle pain in both the short (1-4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term. CONCLUSIONS: Bariatric surgery was associated with better recovery from pain, primarily in weight-bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care.

The frequency of os acromiale in 751 shoulder MRI of Saudi population.

Background: Os acromiale (OA) is an uncommon pathology with a variable prevalence rate among different populations. Objectives: The aim of this study was to report the frequency of OA utilizing shoulder MRI of patients with shoulder pathology. Methods: It was a retrospective study. After obtaining our IRB approval, we gathered all shoulder and upper arm MRIs from the radiology department and evaluated them. Results: The prevalence of OA was found to be 3.32%. The mean age of the affected patients was 50.87 years (25-81). Conclusion: The rate of OA in patients presenting with shoulder pain is 3.32% in Saudi Arabia, which correlates with what has been previously reported in the literature.

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study.

PURPOSE: Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position. METHODS: This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain. RESULTS: Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09). CONCLUSION: The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

Impact of Surgical Positioning on the Occurrence of Postoperative Ipilateral Shoulder Pain After Lung Resection by Video-Assisted Thoracoscopy: A Randomized Trial.

OBJECTIVE: The aim of this study was to evaluate the impact of the ipsilateral arm position on ipsilateral shoulder pain after lung cancer resection by video-assisted thoracic surgery. DESIGN: A prospective randomized controlled trial. SETTING: A single academic center study. PARTICIPANTS: Patients undergoing video-assisted thoracic surgery pulmonary resection for cancer at the Institut Universitaire de Cardiologie et de Pneumologie de Québec from May 2020 to May 2022 were included. INTERVENTIONS: Patients randomly were assigned with a 1:1 ratio to a supported or suspended ipsilateral arm position. MEASUREMENTS AND MAIN RESULTS: Ipsilateral shoulder pain incidence, pain score, and opioid use were recorded in the postanesthesia care unit (PACU) on postoperative days 1 and 2. One hundred thirty-three patients were randomized, 67 in the suspended-arm group and 66 in the supported-arm group. Of the patients, 31% reported ipsilateral shoulder pain in the PACU with no difference between groups (19/67 [28.4%] v 22/66 patients (33.3%), p = 0.5767). There was no significant difference between the pain score in the PACU (3 [0-6] v 4 [0-6], p = 0.9055) at postoperative day 1 (4 [2-6] v 3 [2-5], p = 0.4113) and at postoperative day 2 (2 [0-5] v 2 [1-4], p = 0.9508). Ipsilateral shoulder pain score decreased rapidly on postoperative day 2. There was no statistical difference in opioid and gabapentinoid use between the groups. CONCLUSIONS: Ipsilateral arm position seems to have no impact on ipsilateral shoulder pain.

Characteristics of subscapularis muscle strain in professional baseball players: a case series.

BACKGROUND: Subscapularis muscle strains can develop in professional baseball players, rendering the players unable to continue playing for a certain period. However, the characteristics of this injury are not well known. The purpose of the present study was to investigate the details of the injury and the postinjury course of subscapularis muscle strain in professional baseball players. METHODS: Of 191 players (83 fielders and 108 pitchers) who were members of a single Japanese professional baseball team between January 2013 and December 2022, 8 players (4.2%) had subscapularis muscle strain and were enrolled in this study. The diagnosis of muscle strain was made on the basis of shoulder pain and magnetic resonance imaging findings. The incidence of subscapularis muscle strain, the details of the site of the injury, and the time to return to play were examined. RESULTS: Subscapularis muscle strain occurred in 3 (3.6%) of 83 fielders and 5 (4.6%) of 108 pitchers, with no significant difference between fielders and pitchers. All players had injuries on the dominant side. Most injuries were located at the myotendinous junction and in the inferior half of the subscapularis muscle. The mean time to return to play was 55.3 ± 40.0 (range, 7-120) days. At a mean 22.7 months after the injury, there were no reinjured players. CONCLUSION: A subscapularis muscle strain is a rare injury among baseball players, but in players whose shoulder pain cannot be given a definite diagnosis, subscapularis muscle strain should be considered as a possible etiology.

Glenohumeral internal rotation deficit in general population with shoulder pain: A descriptive observational study.

Glenohumeral internal rotation deficit (GIRD) is one of the most important factors influencing injury risk in the arm of overhead athletes. Some studies have shown that the GIRD of athletes with shoulder pain was higher than those without shoulder pain, establishing a relation between shoulder pain and GIRD. However, there are no studies that relate to GIRD and shoulder pain or the risk factors that affect GIRD in the population with this ailment. This study aimed to: determine if GIRD could be found clinically and between which values it oscillates in patients with shoulder pain, and explore if there are any potential associations between GIRD and some sociodemographic data, and orthopedic or radiological findings. A descriptive observational study design was adopted to determine if GIRD could be found clinically in patients with shoulder pain and to gain further evidence in the potential associations between GIRD and sociodemographic data, and orthopedic or radiological findings. All those patients without exclusion criteria between October 1,2020 and March 31,2021 were included. Exclusion criteria consisted of being under 18 years old but younger than 80 years old, showing shoulder pain in both shoulders and having a joint prosthesis in at least one of the 2 shoulders, tumor, or infection. A total of 67 patients aged between 25 and 75 years (52.7 ±â€…11.8 years, 36 male and 31 female). More than 82% of patients with shoulder pain showed a GIRD higher than 20º. The mean GIRD was 37.6 ±â€…17.09º. The 95th percentile was 66.22º. From sociodemographic data could be extracted that: patients who have children showed a lower GIRD, patients with right shoulder pain, or whose dominance coincided with a painful shoulder showed a higher GIRD. The orthopedic findings revealed that patients with a positive Jobe test showed a lower GIRD. The linear model considering both sociodemographic and orthopedic findings showed that GIRD was reduced by having children and by BMI. GIRD shows a high incidence in patients with shoulder pain. The descendant, BMI, and positive Jobe test were negatively associated with the GIRD.

Influence of extent of surgical resection on post-hepatectomy shoulder pain: an observational study.

Shoulder pain frequently follows hepatectomy. However, the influence of surgical procedures on shoulder pain is unclear. In this observational study, patients who underwent hepatectomy were enrolled in Shanghai Cancer Center. Shoulder pain and surgical pain were assessed using the numeric rating scale 2 days after surgery. The incidence of shoulder pain was the outcome of the cohort study. Nested case-control analyses were further applied. Three hundred and twelve patients were finally enrolled in this study. Nested case-control analysis showed that there were no significant differences in the number of surgical segments between the two groups (P = 0.09). In addition, minor hepatectomy did not reduce the incidence of shoulder pain compared with major hepatectomy (P = 0.37). The drainage volume within 2 days after surgery was significantly more in those patients with shoulder pain (P = 0.017). In open surgery, surgical sites involving the right anterior lobe (OR (95% CI) 2.021 (1.075, 3.802), P = 0.029) and right posterior lobe (OR (95% CI) 2.322 (1.193, 4.522), P = 0.013) were both independent risk factors for shoulder pain. Left shoulder pain also occurred in patients who did not receive left lateral hepatectomy. The preventive phrenic nerve block was not suitable for post-hepatectomy shoulder pain. Stronger preventative intervention should be used in those high-risk patients.

Effect of intraoperative mild hyperventilation on the incidence of shoulder pain after laparoscopic sleeve gastrectomy: A randomized, controlled trial.

BACKGROUNDS: To observe the effect of using mild intraoperative hyperventilation on the incidence of postlaparoscopic shoulder pain (PLSP) in patients undergoing laparoscopic sleeve gastrectomy. METHODS: Eighty patients undergoing laparoscopic sleeve gastrectomy, aged 22 to 36 years, with American Society of Anesthesiologists grade I or II, were divided into 2 groups according to method of random number table. A mild hyperventilation was used in group A with controlling pressure of end-tidal carbon dioxide (PETCO2) of 30 to 33 mm Hg, while conventional ventilation was used in group B with PETCO2 35 to 40 mm Hg during the operation. The incidence and severity of PLSP, dosage of remedial analgesia and adverse reactions such as nausea and vomiting at 12, 24, 48, 72 hours and 1 week after surgery were recorded. Arterial blood gas was recorded before anesthesia induction, 20 minutes after pneumoperitoneum, during suture skin, and 24 hours after surgery. RESULTS: Compared with 12, 24, 48, and 72 hours after operation, the incidence of PLSP at 1 week decreased significantly (P < .01). Compared with group B, the incidence of PLSP, pain score, and dosage of remedial analgesic at 12, 24,48, 72 hours, and 1 week after surgery were significantly decreased (P < .01). There was no significant difference between the 2 groups in arterial blood gas analysis before anesthesia induction, 20 minutes after pneumoperitoneum, during suture skin, and 24 hours after surgery (P > .05). There were no significant difference of the occurrence of adverse reactions such as nausea and vomiting between the 2 groups within 1 week after surgery (P > .05). CONCLUSION: Mild hyperventilation can reduce the incidence and severity of PLSP after laparoscopic sleeve gastrectomy without increasing the associated adverse effects.

The relationship between publication of high-quality evidence and changes in the volume and trend of subacromial decompression surgery for patients with subacromial pain syndrome in hospitals across Australia, Europe and the United States: a controlled interrupted time series analysis.

AIMS: To evaluate the extent to which publication of high-quality randomised controlled trials(RCTs) in 2018 was associated with a change in volume or trend of subacromial decompression(SAD) surgery in patients with subacromial pain syndrome(SAPS) treated in hospitals across various countries. METHODS: Routinely collected administrative data of the Global Health Data@work collaborative were used to identify SAPS patients who underwent SAD surgery in six hospitals from five countries (Australia, Belgium, Netherlands, United Kingdom, United States) between 01/2016 and 02/2020. Following a controlled interrupted time series design, segmented Poisson regression was used to compare trends in monthly SAD surgeries before(01/2016-01/2018) and after(02/2018-02/2020) publication of the RCTs. The control group consisted of musculoskeletal patients undergoing other procedures. RESULTS: A total of 3.046 SAD surgeries were performed among SAPS patients treated in five hospitals; one hospital did not perform any SAD surgeries. Overall, publication of trial results was associated with a significant reduction in the trend to use SAD surgery of 2% per month (Incidence rate ratio (IRR) 0.984[0.971-0.998]; P = 0.021), but with large variation between hospitals. No changes in the control group were observed. However, publication of trial results was also associated with a 2% monthly increased trend (IRR 1.019[1.004-1.034]; P = 0.014) towards other procedures performed in SAPS patients. CONCLUSION: Publication of RCT results was associated with a significantly decreased trend in SAD surgery for SAPS patients, although large variation between participating hospitals existed and a possible shift in coding practices cannot be ruled out. This highlights the complexities of implementing recommendations to change routine clinical practice even if based on high-quality evidence.

Comparing the Effect of Incentive Spirometry and Deep Breathing Exercises on the Level of Shoulder Pain and Nausea Following Laparoscopic Cholecystectomy Surgery: A Clinical Trial Study.

Cholecystitis treated by laparoscopy results in patients experiencing shoulder pain and nausea. Thus, the aim of the present study was to compare the effect of incentive spirometry and deep breathing exercises on the level of shoulder pain and nausea following laparoscopy. In this clinical trial, 105 patients were enrolled into three groups: use of incentive spirometry, deep breathing exercises, and control. Data were collected using a checklist and a visual analog scale and analyzed through the χ2, the Kruskal-Wallis, the Friedman, and the paired t test by SPSS Version 25. In the deep breathing exercise, incentive spirometry, and control groups, mean pain scores immediately after surgery but within 24 hours following the intervention were 3.8, 2.6, and 4.4, respectively. The mean score of severity of nausea for patients in the deep breathing exercise and incentive spirometry groups showed a significant difference immediately after the procedure, as well as at 12 and 24 hours post-intervention. Breathing exercises and incentive spirometry can be effective in reducing pain and nausea in patients undergoing cholecystectomy through laparoscopy. Because of the effectiveness of the two methods, nurses can use incentive spirometery and deep breathing exercises to diminish patients' pain post-cholecystectomy.

The association between cold exposure and musculoskeletal disorders: a prospective population-based study.

OBJECTIVES: The aim of the study was to determine the association between occupational ambient cold exposure and neck-shoulder pain (NSP), low back pain (LBP), and radiating LBP. METHODS: The study cohort comprised of 3,843 working subjects in northern Sweden who answered a baseline (spring 2015) and a follow-up questionnaire (spring 2021). NSP, LBP, and radiating LBP were assessed in both surveys. Occupational cold exposure was assessed at baseline, on a whole number numerical rating scale (NRS) and categorized in quartiles. Binary logistic regression determined the association between cold exposure at baseline and incident NSP, LBP, and radiating LBP, adjusted for age, gender, body mass index, smoking, mental stress, and physical workload. RESULTS: There were statistically significant associations between high occupational ambient cold exposure (NRS 5-7 and NRS 8-10) and NSP (1.59; 95% CI 1.08-2.33 and OR 1.50; 95% CI 1.03-2.19); NRS 8-10 and LBP (OR 1.61; 95% CI 1.13-2.29); and NRS 5-7 and radiating LBP (OR 1.87; 95% CI 1.12-3.16). Gender-stratified analyses showed statistically significant associations between high occupational ambient cold exposure (NRS 5-7 and NRS 8-10) and NSP (OR 1.97; 95% CI 1.07-3.61 and OR 1.97; 95% CI 1.06-3.67) for men and between NRS 8-10 and LBP (OR 1.82; 95% CI 1.14-2.91) and NRS 5-7 and radiating LBP (OR 2.20; 95% CI 1.15-4.24) for women. CONCLUSIONS: Occupational ambient cold exposure was associated with NSP, LBP, and radiating LBP, and should be recognised as a possible occupational risk factor.

Patients with low body mass index are more likely to develop shoulder pain after laparoscopy.

INTRODUCTION: Shoulder pain is one of the most common complications after laparoscopy. Previous studies have found a number of methods to reduce shoulder pain after laparoscopic surgery, but these methods have not been targeted to specific populations. The purpose of this study was to identify people who are more likely to develop shoulder pain. MATERIAL AND METHODS: A total of 203 patients underwent laparoscopy for benign gynecological diseases between July 2020 and February 2021. Patients were divided into two groups according to the Chinese overweight standard, body mass index less than 24 kg/m2 group and 24 kg/m2 or more group. The baseline characteristics and intraoperative data between the two groups were compared. The intensity of the shoulder pain was quantified using a visual analog scale (VAS). RESULTS: The incidence and the VAS scores of shoulder pain were significantly higher in the less than 24 kg/m2 group (63.64% vs 38.03%, p < 0.001 in incidence; median 5 (interquartile range [IQR] 3-7) vs 3 (IQR 2-5), p < 0.001 in VAS scores), and the chance of shoulder pain within 24 hours after laparoscopy was higher in the less than 24 kg/m2 group (89.29% vs 66.67%, p = 0.013). In univariate and multivariate logistic regression analysis, BMI less than 24 kg/m2 was an independent risk factor of shoulder pain after laparoscopic surgery (p = 0.001, p = 0.031, respectively). Shoulder pain scores were inversely correlated with BMI (r = -0.300, p = 0.001). CONCLUSIONS: Patients with low body mass index are more likely to develop shoulder pain after laparoscopy, with earlier onset and higher pain scores.

MRI findings of acromioclavicular joint osteoarthritis are the norm after age 40.

BACKGROUND: Acromioclavicular joint (AC) arthritis (A) is a common incidental finding on shoulder imaging. An improved knowledge of the age- and sex-specific prevalence (or base rate) of incidental ACA can inform diagnosis and treatment strategies for shoulder pain. HYPOTHESIS: There is no relationship between age or gender and the presence or severity of MRI findings consistent with osteoarthritis of the acromioclavicular joint. METHODS: We rated ACA on 475 MRIs from a database of patients who had MRIs for non-AC indications. The cohort consisted of 51% men, 49% women and had an average age of 55. Bivariate analyses were used for analysis of age and sex-specific prevalence. RESULTS: The prevalence of findings consistent with ACA on MRI for non-AC indications was 83%. The prevalence increased from 75% between ages 40 and 50 to 100% after age 70. Logistic regression demonstrated an association between age and ACA (Odds Ratio 2.89; 95% confidence interval [CI]=2.30 to 3.63; p=0.001). No difference was seen by sex (Chi-Square, 0.16; p=0.67). There was a positive correlation between age and ACA severity (Spearman's rho=0.43; p=0.000010). DISCUSSION: The observation that MRI evidence of ACA is the norm (75%) after age 40 and is universal with human aging (100% after age 70), makes it very difficult to discern ACA as a cause of shoulder symptoms. Given the near universal prevalence of radiological ACA, imaging cannot be used as a reference standard for diagnosis of symptomatic ACA based on symptoms and signs. LEVEL OF EVIDENCE: Not applicable.

[Investigation of the occurrence of musculoskeletal disorders at shoulder, neck and elbow of digestive endoscopy operators].

Objective: To investigate the effect of endoscopic operation volume on musculoskeletal disorders (MSDs) of shoulder, neck and elbow. Methods: From December 2019 to March 2020, random sampling was used to select 200 gastroenterologists from hospitals at or above the municipal level in Sichuan Province as the research object. Gastroenterologists were divided into 108 eadoscop in the low operation group (The operation volume is less than 5 000 cases) and 92 eadoscop in the high operation group (The operation volume is more than 5 000 cases) according to the operation volume. MSDS was investigated by UCLA shoulder scoring system, Tanaka Jingjiu cervical spondylosis scale and improved An and Morrey elbow scoring system, and the chi-square test was used to compare the basic conditions of different body parts in the two groups. The basic condition of each part of the two groups was tested and compared. Results: Compared with the low operation group, the age and working years of the high operation group were longer, and the difference was statistically significant (P<0.001). The most painful part between the two groups was the shoulder, accounting for 25.9% (28/108) and 37.0% (34/92), respectively. Occasional shoulder pain was the most (41.9%, 26/62) and normal function was the most (32.3%, 20/62) ; The forward flexion angle exceeds 150° at most (40.3%, 25/62). Slight pain often occurred in the neck, accounting for 57.7% (15/26), the occasional impact of pain on the upper limbs accounted for 61.5% (16/26), and the impact on the fingers accounted for 53.8% (14/26) ; 65.0% (15/26) had mild disturbance to the sense of signs; Normal tendon reflex accounted for 88.5% (23/26) ; The influence of opponents was weakness, discomfort and no dysfunction, accounting for 53.8% (14/26) ; Endoscopists with normal muscle strength (2 points) and mild decline accounted for 50.0% (13/26) respectively, and there was no significant difference among the groups (P=0.234、1.000、1.000、0.050、0.680、0.539、0.431、0.239). The elbow score scale showed that mild loss accounted for 55.0% (11/20), mild instability accounted for 65% (13/20), and mild pain accounted for 55.0% (11/20) . Conclusion: MSDs is a health problem faced by endoscopists, and targeted preventive measures should be taken for its possible causes.

Effect of Intraoperative Phrenic Nerve Infiltration on Postoperative Ipsilateral Shoulder Pain After Thoracic Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

OBJECTIVES: This meta-analysis was aimed at investigating the effectiveness and safety of phrenic nerve infiltration (PNI) against ipsilateral shoulder pain (ISP) after thoracic surgery. DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: Operating room. PARTICIPANTS: Patients undergoing thoracic surgery. INTERVENTIONS: PNI. MEASUREMENTS AND MAIN RESULTS: MEDLINE, Cochrane Library, and EMBASE databases were searched from inception through December 2021. The primary outcome was the overall incidence of ISP, with secondary outcomes including incidence and severity of ISP at postoperative 6, 24, and 48 hours. Six RCTs involving 482 patients undergoing thoracic surgery were included. Pooled results found a significantly lower incidence of overall ISP in patients with PNI (ie, 23.6%) compared to those without (ie, 53.2%; risk ratio: 0.46, 95% confidence interval: 0.34-0.61; I2 = 19%; 6 RCTs; n = 474; certainty of evidence = high). At postoperative 6, 24, and 48 hours, there was also a significantly lower incidence of ISP in the PNI group than in the control group (certainty of evidence for all outcomes = high). Besides, the severity of ISP was lower in the PNI group at 6 (certainty of evidence = moderate) and 24 hours (certainty of evidence = high), with insufficient data for analysis at 48 hours because of only 1 trial. CONCLUSION: This meta-analysis showed that PNI not only reduced the incidence but also improved the severity of ipsilateral shoulder pain after thoracic surgery with a prophylactic effect lasting up to 48 hours. The limited number of included studies warrants further research to support these findings.

Persistent Shoulder Pain After Vaccine Administration Is Associated with Common Incidental Pathology: A Systematic Review.

BACKGROUND: Claims of shoulder injury now account for half of all claims to the Vaccine Injury Compensation Program. Reports from databases of claims or potential adverse events note a relatively high mean age and high prevalences of rotator cuff tendinopathy and adhesive capsulitis-common shoulder problems that might be incidental to vaccination. Published case reports provide much more detail about individual patients than is available in databases. A review of published cases provides an opportunity for more detailed review of symptoms, diagnoses, pathology, treatment, and prognosis. Such a review can better assess the relative likelihood that pathologies associated with new persistent shoulder symptoms after vaccination are coincidental or unique to and caused by vaccine. QUESTIONS/PURPOSES: Regarding published case reports addressing persistent shoulder pain after vaccination: (1) In what proportion of patients was a specific diagnosis made? (2) What diagnoses were most common? (3) Among patients treated nonsurgically, what proportion resolved, and over what time span did they resolve? METHODS: In August 2020, we searched PubMed and Embase between 2006 and 2020 using the following search strategy: Search 1: (shoulder dysfunction OR shoulder pain OR shoulder bursitis OR rotator cuff tendonitis OR adhesive capsulitis OR glenohumeral arthritis AND [vaccine OR vaccination OR immunization]); Search 2: (shoulder injury related to vaccine administration or SIRVA). The search was supplemented by reviewing reference lists of identified studies. Inclusion criteria were any detailed report of three or fewer cases involving shoulder pain after vaccine administration. Twenty published reports of 29 patients were identified and assessed by two reviewers independently. One reported glenohumeral joint infection was excluded because the relationship between this type of relatively uncommon, discrete diagnosis and vaccination raises different considerations. We assumed a high risk of bias, although we are not aware of bias assessment tool for case reports. We recorded and summarized patient demographics, symptoms, examination and imaging findings, surgery findings, diagnoses, treatments, and outcomes. Seventy-five percent (21 of 28) of patients were women, with a mean age of 54 ± 19 years. In search of an underlying pathology, at least one diagnostic study was performed in 82% (23 of 28) of patients including radiographs in seven, ultrasound in seven, and MRI in 16 patients (some patients underwent more than one type of imaging). We distinguished specific pathophysiological diagnosis from shoulder pain and stiffness, counted the most common diagnoses among patients a specific diagnosis, and tracked symptom resolution among patients treated nonoperatively. RESULTS: A specific diagnosis was made in 57% (16 of 28) of patients. Twelve patients had pain and limitation of motion due to pain but no specific pathological diagnosis. The most common specific diagnoses were rotator cuff tendinopathy (9 of 16) and adhesive capsulitis (4 of 16). Less common specific diagnoses included rotator cuff arthropathy (and rheumatoid arthritis) and suspected septic arthritis with nonspecific synovitis on arthroscopy. One patient had transient MRI signal change in the humeral head, which was interpreted as osteonecrosis that resolved in a manner not typical for that diagnosis. Of the 17 patients treated nonsurgically, 15 reported resolution, and two had incomplete symptom resolution with the mean 6-month evaluation period. CONCLUSION: The observation that persistent shoulder pain after vaccination overlaps with common shoulder pathology-both in large databases as well as in more detailed reports of specific patients as analyzed in this review-establishes a high probability of a coincidental rather than a causal association. In the absence of high-quality experimental evidence of vaccine-specific shoulder pathology, in our opinion, it seems safest and healthiest to assume that perceived shoulder injury related to vaccine administration (SIRVA) is due to misinterpretation of new symptoms from established pathology rather than a new, vaccine-specific pathology. LEVEL OF EVIDENCE: Level IV, therapeutic study.

The Relationship of Aging and Smoking With Rotator Cuff Disease: A Systematic Review and Meta-analysis.

OBJECTIVE: Despite rotator cuff disease being one of the most common causes of shoulder pain, its pathogenesis and biology are poorly understood. In this study, we synthesized evidence from studies reporting associations for aging and smoking status in relation to rotator cuff disease. DESIGN: A systematic review was performed using multiple databases (PubMed, Embase, Cochrane, CINAHL, and Science Direct). Articles that met our eligibility criteria and presented data on the association between aging and/or smoking status and rotator cuff disease were included. We performed meta-analyses and reported cumulative effects using odds ratios and corresponding 95% confidence intervals. RESULTS: Of the 212 articles eligible for full-text review, seven studies reported on the relationship between aging and rotator cuff disease, and 10 studies reported on the relationship between smoking and rotator cuff disease. Aging was consistently associated with increased odds of having rotator cuff disease when assessed continuously (per 10-yr increase: odds ratio = 1.20, 95% confidence interval = 1.18-1.21) or categorically (ages <40 yrs vs: [a] 40-44 yrs [odds ratio = 2.71, 95% confidence interval = 1.78-4.13], [b] 45-49 yrs [odds ratio = 4.33, 95% confidence interval = 2.88-6.55], and [c] ≥50 yrs [odds ratio = 6.97, 95% confidence interval = 4.85-10.01]). Assessing studies that reported smoking status as current smokers versus nonsmokers, current smokers were more likely to have rotator cuff disease (odds ratio = 1.94, 95% confidence interval = 1.52-2.48). However, a statistically significant association was not found when never smokers were compared with former smokers (odds ratio = 1.08, 95% confidence interval = 0.97-1.20) and to current smokers (odds ratio = 0.97, 95% confidence interval = 0.87-1.07). CONCLUSIONS: In this systematic review and meta-analysis, increasing age was a strong risk factor for rotator cuff disease. The finding that current smokers are more likely to have rotator cuff disease as compared with nonsmokers implies that cessation of smoking can potentially lead to mitigation of this risk factor.

Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety.

BACKGROUND: The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. METHODS: We recruited dental hygiene (DH) students (n = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (n = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasonography, and psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog scale for pain score greater than the minimal clinically important difference) between DH and OT students using Fisher exact test. We used mixed effects models to longitudinally compare the change in outcomes between 3 groups: DH students who develop and did not develop shoulder pain, and OT students. RESULTS: The incidence of shoulder pain is higher in DH students (relative risk = 4.0, 95% confidence interval [CI] 1.4, 11.4). After 1 year, DH students with pain had the greatest thickening of the supraspinatus (0.7 mm, 95% CI 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4 mm, 95% CI 0.1, 0.8) and OT students (0.9 mm, 95% CI 0.5, 1.2). Anxiety score increased 3.8 points (95% CI 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at 1 year (relative risk = 2.9, 95% CI 1.0, 8.6). CONCLUSION: Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and it thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

Effect of fentanyle versus dexamethasone on shoulder tip pain during laparoscopic ovarian cystectomy under spinal anaesthesia / Omalgia luego de quistectomía ovárica laparoscópica, efecto de fentanyl comparado con dexametasona

BACKGROUND: General anesthesia (GA) was the usual anesthetic technique used for laparoscopic interventions, however regional anesthesia in the laparoscopic field started to gain familiarity. Shoulder pain is a major intraoperative problem that might hinder facilitation of laparoscopic interventions under spinal anesthesia. AIM OF THE STUDY: Evaluate the effect of intrathecal addition of dexamethasone versus fentanyl on incidence and severity of intraoperative shoulder tip pain during gynecological laparoscopic asurgeries. Methods: 120 patients, were randomly assigned into three groups. Group D: 40 patients received 15 mg bupivacaine and 8 mg dexamethasone intrathecally. Group F: 40 patients received 15 mg bupivacaine and 25 pg fentanyle intrathecally. Group C: 40 patients received 15 mg bupivacaine and normal saline intrathecally. RESULTS: Number of patients who experienced intraoperative shoulder pain was significantly lower in Group F (17) and Group D (19) than Group C (31); P = 0.008. with no ststistical difference detected between Group D and C (p value 1). Only 2 patients in Group D and F suffered moderate pain intensity in comparison to 9 patients in Group C; P =0.02. Incidence of postspinal shivering was lower in Group D and F in comparison to Group C; P 0.02. CONCLUSION: Intrathecal dexamethasone is as effective as intrathecal fentanyle in reducing incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.

INTRODUCCIÓN: La anestesia general (AG) era la técnica anestésica habitual utilizada para las intervenciones laparoscópicas, sin embargo, la anestesia regional en el campo laparoscópico comenzó a ganar familiaridad. El dolor de hombro es un problema intraoperatorio importante que podría dificultar la facilitación de las intervenciones laparoscópicas bajo anestesia espinal. OBJETIVO DEL ESTUDIO: Evaluar el efecto de la adición intratecal de dexametasona versus fentanilo sobre la incidencia y severidad del dolor intraoperatorio en la punta del hombro durante cirugías laparoscópicas ginecológicas. MÉTODOS: 120 pacientes, fueron asignados aleatoriamente en tres grupos. Grupo D: 40 pacientes recibieron 15 mg de bupivacaína y 8 mg de dexametasona por vía intratecal. Grupo F: 40 pacientes recibieron 15 mg de bupivacaína y 25 pg de fentanilo por vía intratecal. Grupo C: 40 pacientes recibieron 15 mg de bupivacaína y solución salina normal por vía intratecal. RESULTADOS: El número de pacientes que experimentaron dolor de hombro intraoperatorio fue significativamente menor en el Grupo F (17) y el Grupo D (19) que en el Grupo C (31); P = 0,008. sin diferencia estadística detectada entre el Grupo D y C (valor de p 1). Solo 2 pacientes del Grupo D y F sufrieron dolor de intensidad moderada en comparación con 9 pacientes del Grupo C; P = 0,02. La incidencia de escalofríos posespinales fue menor en el Grupo D y F en comparación con el Grupo C; P 0,02. CONCLUSIÓN: La dexametasona intratecal es tan eficaz como el fentanilo intratecal para reducir la incidencia y la gravedad del dolor en la punta del hombro durante la cistectomía ovárica laparoscópica bajo anestesia espinal.

Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program.

BACKGROUND: Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery. METHODS: This cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS. RESULTS: There were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12-11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36-31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS. CONCLUSIONS: A high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.