Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis.

Background: The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. Objective: To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. Method: The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Results: Eight studies (N = 604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p < 0.01, HG = -1.30), external rotation (I2 = 83.2%, p < 0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p < 0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p < 0.05, HG = -0.3). Conclusions: There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.

Factors predicting long-term outcomes following physiotherapy in patients with subacromial pain syndrome: a secondary analysis.

BACKGROUND: Although patients with shoulder complaints are frequently referred to physiotherapy, putative predictive factors for outcomes are still unclear. In this regard, only a limited amount of scientific data for patients with subacromial pain syndrome exist, with inconsistent results. An improved knowledge about the ability of baseline variables to predict outcomes could help patients make informed treatment decisions, prevent them from receiving ineffective treatments, and minimize the risk of developing chronic pain. AIM: The aims of this secondary longitudinal analysis are threefold: First, to investigate baseline differences between patients with and without successful long-term outcomes following physiotherapy. Second, to compare the predictive ability of two sets of putative predictive variables on outcomes, one based on the literature and one based on the data of the original trial. Third, to explore the contribution of short-term follow-up data to predictive models. METHODS: Differences between responders and nonresponders were calculated. The predictive ability of variables defined through literature and of variables based on the Akaike Information Criterion (AIC) from the original trial dataset on the Shoulder Pain and Disability Index and the Patients' Global Impression of Change at the one-year follow-up were analyzed. To test the robustness of the results, different statistical models were used. To investigate the contribution of follow-up data to prediction, short-term data were included in the analyses. RESULTS: A sample of 87 patients with subacromial pain syndrome was analyzed. 77% (n = 67) of these participants were classified as responders. Higher expectations and short-term change scores were positive, and higher fear avoidance beliefs, greater baseline disability and pain levels were negative predictors of long-term outcomes in patients with subacromial pain syndrome. CONCLUSIONS: Although our results are in line with previous research and support the use of clinical factors for prediction, our findings suggest that psychological factors, especially patient expectations and fear avoidance beliefs, also contribute to long-term outcomes and should therefore be considered in the clinical context and further research. However, the hypotheses and recommendations generated from our results need to be confirmed in further studies due to their explorative nature. TRIAL REGISTRATION: The original trial was registered at Current Controlled Trials under the trial registration number ISRCTN86900354 on March 17, 2010.

Effects of a web application based on multimedia animations to support therapeutic exercise for rotator cuff-related shoulder pain: protocol for an open-label randomised controlled trial.

INTRODUCTION: Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain. Currently, exercise is proposed as the first-line treatment for patients suffering from RCRSP. However, adherence to therapeutic exercise programmes can be poor in the long term in a home setting. The aim of this study is to evaluate the effects of adding video animations to a traditional paper-based exercise programme. METHODS AND ANALYSIS: A single-centre, randomised, open-labelled clinical trial will be conducted in a hospital in Spain. Adults aged between 18 and 80 years diagnosed with RCRSP who meet the eligibility criteria will be included. Patients (n=132) will be randomised into two groups, with both receiving paper-based exercises, and the experimental group will also be provided with video animations. The participants will receive seven face-to-face physical therapy sessions and will be asked to perform the exercises at home for 6 months. The primary outcome measure will be the Shoulder Pain and Disability Index, measured at baseline, 3 weeks, 3 months (primary analysis) and 6 months. Secondary outcomes will be the patient's pain intensity during the last week (rest, during movement and at night); expectations of improvement; satisfaction with treatment; impression of improvement; perceived usability, usefulness and satisfaction of multimedia animations; and adherence to exercises. Generalised least squares regression models with an autoregressive-moving average lag one correlation structure will be implemented, with an intention-to-treat analysis. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of Hospital Universitario Fundación Alcorcón (Madrid, Spain), reference number CI18/16. All participants will sign an informed consent. The results will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05770908.

Combined Prolotherapy and Physical Therapy in a 60-Year-Old Man with Left Shoulder Pain and Limited Range of Motion (Frozen Shoulder) Following a Hemiplegic Stroke: A Case Report.

BACKGROUND Frozen shoulder with limited range of motion is a common and debilitating condition that occurs on the affected side following a stroke. The effectiveness of therapy was reported to be negatively correlated with the complexity of pathogenesis. Prolotherapy involves injection into the joint of a small amount of irritant, such as dextrose, which enhances tissue strength and facilitates healing by targeting joint spaces. The treatment is used to relieve pain. This report describes the effects of combined prolotherapy and physical therapy in a 60-year-old man with left shoulder pain and limited range of motion (frozen shoulder) following a hemiplegic stroke. CASE REPORT A 60-year-old man had left shoulder pain and limited ROM for 9 months, which disrupted daily life, with a NRS of 7 and a DASH score of 58.3%. The patient had an ischemic stroke 1 year ago, with left extremity weakness. On physical examination, joint active ROM was significantly restricted and the joint was tender upon palpation. Therapy is carried out using prolotherapy combined with exercise and physical therapy for 6 weeks. At the 6-week follow-up, he had good outcomes for pain relief, increasing ROM, and quality of life. CONCLUSIONS The use of prolotherapy with physical therapy may be an effective treatment for painful frozen shoulder following a hemiplegic stroke.

Evaluation of the Relationship between Acromiohumeral Distance and Supraspinatus Tendon Thickness Measured by Ultrasonography and Rotator Cuff Pathologies, Pain, and Function.

PURPOSE OF THE STUDY: In this study, we aimed to evaluate acromiohumeral distance (AHD) and supraspinatus tendon (ST) thickness measurements and their relationship with pain and function in ST pathologies. MATERIAL AND METHODS: The study included 111 patients and 25 healthy controls (HC). Patients were divided into 3 groups according to their diagnosis: non-tear tendinopathy (NTT), partial thickness tear (PTT), and full thickness tear (FTT). The AHD and ST thickness of the participants were measured with ultrasound. The pain and functional status of the patients were evaluated with the Numeric Rating Scale (NRS), The QuickDASH shortened version of the DASH Outcome Measure - Disabilities of the Arm Shoulder and Hand (QDASH), and Simple Shoulder Test (SST). RESULTS: The AHD value was significantly higher in the NTT group (p=0.000). The AHD value was significantly lower in the FTT group (p=0.000). ST thickness value was significantly lower in the PTT group compared to the NTT group (p=0.000). There was a positive correlation between ST thickness and BMI (r=0.553,p<0.01). There was a negative correlation between ST thickness and SST and a positive correlation between ST thickness (r=-0.223,p<0.05) and QDASH (r=0.276,p<0.05). CONCLUSIONS: We found that AHD and SST thicknesses significantly differed in the NTT, PTT, FTT, and HC groups. This difference may be important for diagnosis. In addition, the effect of obesity on ST thickness and the relationship between ST thickness and functional scores may be considered. Weight control may be effective at this point. KEY WORDS: acromiohumeral distance, supraspinatus tendon thickness, ultrasound.

Shoulder Pain - Don't Forget First Rib Fractures.

First rib fractures are uncommon, mainly in paediatric population, considering its anatomic features and their skeleton plasticity. Traditional teaching usually characterizes it as a hallmark of severe trauma. Herein, to unfold awareness to an unnoticed diagnosis, we describe two paediatric cases of isolated first rib fracture in adolescents without a clear identifiable cause nor an underlining trauma mechanism. Neurovascular injuries should always be investigated, as fracture of the first rib with ensuing callus formation is a rare but fearing cause of thoracic outlet syndrome. We highlight the scarcity of reports on isolated first rib fractures outside of sports medicine, as well as the importance of considering this otherwise easily missed diagnosis in a common complaint in children.

Phrenic Nerve Block for Diaphragmatic Pain: Case Report.

Referred chronic shoulder pain may arise from diaphragmatic irritation. It can potentially be alleviated by blockade of the phrenic nerve. There is literature describing its use in acute pain conditions; yet for chronic pain, there are no reports. We present 2 cases of chronic diaphragmatic irritation causing ipsilateral referred shoulder pain. Patients experienced significant pain relief and a reduction in opioid consumption after receiving an ultrasound-guided phrenic nerve block. While the phrenic nerve block shows promise for pain relief, carefully evaluating its benefits and risks is recommended before considering its application in selected cases.

[Comparison of mid-term effectiveness between diabetic secondary stiff shoulder and primary frozen shoulder after arthroscopic shoulder capsular release combined with acromiohumeral distance restoration].

Objective: To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. Methods: A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films. Results: All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( P<0.05), there was no significant difference in other indicators between the two groups ( P>0.05). Conclusion: Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.

Is playing ma-jong, chess and cards associated with a lower incidence of shoulder pain in Chinese elderly adults? The cross-sectional and longitudinal evidence from CHARLS.

BACKGROUND: The association between playing Ma-jong, chess and cards (PMCC) and shoulder pain among elderly adults in China remains unclear. The present study aimed to examine the association based on a nationally representative large-scale survey. METHODS: The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. All subjects met the inclusion criteria were classified based on the results of the CHARLS wave questionnaire. Logistic regression models were conducted to analyze the cross-sectional and longitudinal association between PMCC and shoulder pain. Odds ratios (OR) were reported to indicate the strength of the association. RESULTS: In total, 8125 participants aged over 60 years (48.3 % male; mean age 67.9 ± 6.4 years) were enrolled in a cross-sectional association study in 2015, and further 6861 elderly adults were followed up in 2018. The overall prevalence of shoulder pain in the cross-sectional population was 15.6 %. In the non-PMCC and PMCC groups, the incidence of shoulder pain was 16.6 % and 10.7 %, respectively (P < 0.001). In the fully adjusted model, the results showed a significant association between PMCC and shoulder pain (OR: 0.798, 95 % CI: 0.662-0.963, P = 0.018). In the longitudinal analysis from 2015 to 2018, the incidence of new-occurrence shoulder pain in non-PMCC and PMCC groups was 22.1 %, and 18.5 %, respectively (P = 0.004). In the fully adjusted model, compared with the non-PMCC group, the risk of the occurrence of shoulder pain for individuals with PMCC was lower (OR: 0.832, 95 % CI: 0.709-0.975, P = 0.023). CONCLUSIONS: PMCC is associated with lower incidence of shoulder pain, which provides evidence for PMCC as a potential protective factor in the occurrence of shoulder pain.

[Long head of the biceps pathologies : diagnosis and treatments]. / Diagnostics et traitements des pathologies du long chef du biceps.

The long head of the biceps (LHB) tendon is a common source of shoulder pain. Often associated with other injuries, the tendon can alone be responsible of the symptoms. Spontaneous rupture has been observed to allow for pain relief. The spectrum of LHB lesions is broad. Repetitive motion, carrying heavy loads, have been associated with diagnosis. Specific tests have been described to diagnose biceps injuries, their implementation can remain difficult in the presence of associated pathologies. The combination of a history and clinical examination with the use of targeted imaging is required to establish the diagnosis. The management of bicipital pathologies is frequently carried out following main surgical procedures. Isolated management of biceps lesions can provide a satisfactory result when a comprehensive procedure cannot be performed.

Le tendon du long chef du biceps (LCB) est une source fréquente de douleurs à l'épaule. Souvent associé à d'autres atteintes, il peut être seul responsable de la symptomatologie et sa rupture peut apporter un soulagement « salvateur ¼. Le spectre des lésions du LCB est large. Les mouvements répétés de lancer, tirer ou le port de charges ont été associés à une atteinte du LCB. De nombreux examens spécifiques ont été développés afin de diagnostiquer ces lésions. Leur réalisation peut rester un défi clinique en cas de pathologies associées. Une anamnèse, un examen clinique ainsi qu'une imagerie ciblée sont requis pour établir le diagnostic. La prise en charge de ces lésions est souvent réalisée durant des procédures chirurgicales principales. Leur prise en charge isolée permet un résultat fonctionnel satisfaisant lorsqu'un geste exhaustif ne peut être réalisé.

[Prognostic factors for substantial clinical benefit from musculoskeletal pathologies of the shoulder]. / Factores pronósticos de beneficio clínico sustancial en patologías musculoesqueléticas de hombro.

INTRODUCTION: shoulder plain is a common cause of complain, however a precise diagnosis is hard to achieve. This is why finding factors associated to a good prognosis could help to improve our clinical practice. OBJECTIVE: to identify demographic and clinical characteristics from the initial assessment associated with substantial clinical benefit (SCB) in patients with shoulder pain one month after treatment or at patient's discharge. MATERIAL AND METHODS: this was a secondary analysis of a prospective cohort of patients with shoulder pain. Demographic and clinical (self-reported scales) factors associated with SCB at discharge or four weeks after the initial assessment, were analyzed. SCB was defined as a score +5 on a Global Rating of Change. A logistic regression model was made in order to identify predictors of SCB. The area under the curve ROC was used to assess the performance of the model with its independent variables. RESULTS: 101 patients of 138 were analyzed. The median age was 55 (RIQ 37-61) years old, there were 55 (54.5%) women in the sample. The variables independently associated to SCB were fracture as a reason for admission [adjusted OR 11.8 (95% CI 1.4-101.8); p = 0.024], and durations of shoulder symptoms shorter than seven months [adjusted OR 4.63 (95% CI 1.9-11.1); p = 0.001]. CONCLUSION: the diagnosis of fracture and durations of shoulder symptoms shorter than seven months were independently associated with a SCB after one month of treatment or at the patient's discharge.

INTRODUCCIÓN: las patologías de hombro representan una condición clínica frecuente, pero suele ser complejo realizar un diagnóstico preciso. Es por esto, que conocer qué variables permiten realizar un pronóstico del resultado del tratamiento puede ser útil para la práctica clínica. OBJETIVO: el objetivo del presente estudio fue identificar características clínicas y demográficas asociadas a beneficio clínico sustancial (BCS) en pacientes con afecciones musculoesqueléticas de hombro al mes o al alta del inicio de tratamiento fisioterápico. MATERIAL Y MÉTODOS: se realizó un análisis secundario de una cohorte prospectiva de pacientes con dolor de hombro. Se evaluó qué factores demográficos y clínicos se asociaban a BCS. Se consideró BCS un puntaje +5 en la Global Rating of Change. Se realizó un modelo de regresión logística para identificar predictores de BCS. A su vez, se utilizó el área bajo de la curva ROC para determinar el desempeño del modelo con sus respectivas variables independientes. RESULTADOS: de 138 sujetos se analizaron 101 pacientes. La mediana de edad fue de 55 (RIQ 37-61) años, hubo 55 (54.5%) mujeres dentro de la muestra. Las variables que se asociaron independientemente a BCS fueron fractura como motivo de ingreso [OR ajustado 11.8 (IC95% 1.4-101.8); p = 0.024] y tiempo de evolución menor a siete meses [OR ajustado 4.63 (IC95% 1.9-11.1); p = 0.001]. CONCLUSIÓN: el diagnóstico de fractura y el tiempo de evolución menor a siete meses se asociaron de manera independiente a BCS al cumplir un mes de tratamiento kinésico o al alta.

Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial.

BACKGROUND: Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem. METHODS: This study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score. DISCUSSION: Ultrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function. TRIAL REGISTRATION: Chinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722 .

Patient experiences of hydrodistension as a treatment for frozen shoulder: A longitudinal qualitative study.

BACKGROUND: Frozen shoulder is a condition associated with severe shoulder pain and loss of function impacting on a persons' physical and mental health. Hydrodistension treatment that has been widely adopted within the UK National Health Service for the condition. However, evidence of clinical effectiveness and understanding of the patient experiences of this treatment are lacking. This study explored the experiences of people with a frozen shoulder who received hydrodistension treatment. METHODS: A qualitative design with repeat semi-structured interviews was used to explore participants' experiences of hydrodistension treatment. Participants were interviewed 2-4 weeks and again at 8-10 weeks after treatment. Interviews were audio-recorded and transcribed verbatim. Findings were analysed using an inductive thematic analysis framework. The study is reported in accordance with the consolidated criteria for reporting qualitative (COREQ) research. RESULTS: 15 participants were interviewed online or over the phone. Three themes were identified: 'Preparing for and having a hydrodistension', 'Physiotherapy after hydrodistension', and 'Outcome of hydrodistension '. Participants believed hydrodistension would benefit them, was well tolerated by many, and the effects were apparent to most within the first week. Physiotherapy still seemed to be valued to support recovery beyond this timepoint, despite these early effects. Some participant's experienced harms including severe procedural pain and blood sugar dysregulation. CONCLUSION: This is the first study to investigate the experiences of people who undergo hydrodistension for frozen shoulder. Hydrodistension appears an acceptable treatment to participants with a frozen shoulder, acceptability is enhanced through adequate shared decision making. Further high-quality research is required to understand the comparative effectiveness of hydrodistension as a treatment for frozen shoulder, including adverse events, and the benefit of treatment by a physiotherapist after hydrodistension.

Evaluation of the segmental distribution of pain sensitivity among patients with central sensitization associated with chronic subacromial pain syndrome: A cross-sectional study.

INTRODUCTION: Pain sensitivity is the main finding of central sensitization (CS) and can occur in patients with chronic shoulder pain. However, there is limited evidence concerning the distribution of pain sensitivity in shoulders, forearms, and legs in patients with CS associated with chronic shoulder pain. The present study aimed to determine the distribution of pain sensitivity in patients with CS associated with chronic subacromial pain syndrome (SPS). METHOD: This cross-sectional study included 58 patients with chronic SPS and CS (patient group) and 58 healthy participants (control group). The presence of CS was determined using the Central Sensitization Inventory (CSI). To determine the distribution of pain sensitivity, pressure pain threshold (PPT) measurements were performed from the shoulders, forearms, and legs. RESULTS: There was no significant difference between the two groups in terms of sociodemographic data (p > 0.05). The patient group had a significantly higher CSI score (p < 0.001) and lower PPTs in all regions (p < 0.05) than the control group. Unlike the control group, the patient group had lower PPTs on the affected side for the shoulder [mean difference (MD) 95% confidence interval (CI): 1.2 (-1.7 to -0.6)], forearm [MD 95% CI: 1.1 (-1.7 to -0.6)], and leg [MD 95% CI: 0.9 (-1.4 to -0.3)] compared with the contralateral side (p < 0.001). CONCLUSION: Pain sensitivity is more pronounced in the affected shoulder and the forearm and leg located on this side than in those on the contralateral side in patients with CS associated with chronic SPS.

Motor alterations along the kinetic chain in amateur volleyball and handball athletes with shoulder pain: An observational comparative study.

Overhead sports overload the shoulder complex due to movement repetition and the great amount of force created during the athletic motion, which may cause adaptations in the shoulder and lead to shoulder pain. However, overhead movements include the kinetic chain, and alterations in some of the structures throughout the kinetic chain may increase stress on the shoulder complex and be associated with shoulder pain. PURPOSE: To compare kinetic chain components in overhead athletes with and without shoulder pain. METHODS: Forty-one volleyball and handball athletes (21 with and 20 without shoulder pain) were included and assessed for hip internal (IR) and external rotation (ER) range of motion (ROM), hip and trunk isometric strength, trunk endurance and neuromuscular control of the lower and upper limbs (Y balance test). RESULTS: Athletes with shoulder pain showed smaller IR ROM in both hips, lower endurance time for trunk extensors and flexors, decreased reach distance in the anterior and posteromedial direction, as well as a smaller composite score in the Y balance test (p < 0.05). CONCLUSION: Volleyball and handball athletes with shoulder pain showed changes in ROM throughout the kinetic chain in addition to lower core endurance, and decreased neuromuscular control of lower limbs.

Will my shoulder pain get better? - secondary analysis of data from a multi-arm randomised controlled trial.

OBJECTIVE: To determine whether higher level or improvements over time in pain self-efficacy (PSE) and expectations of intervention effectiveness lead to better outcomes and whether the intervention used to manage rotator cuff related shoulder pain (RCRSP) impacts PSE and expectations over time. DESIGN: Secondary analysis of data from a randomised controlled trial. PARTICIPANTS: 123 individuals (48 [15] years old; 51% female) with RCRSP. INTERVENTIONS: Participants randomised into one of three 12-weeks interventions (education; education and motor control exercises; education and strengthening exercises). MAIN OUTCOME MEASURES: QuickDASH and Western Ontario Rotator Cuff Index (WORC) were administered at baseline and 12 weeks. Pain self-efficacy was assessed at 0 and 6 weeks. Patients' expectations regarding intervention effectiveness were assessed before randomisation and after the first and the last intervention sessions. NparLD were used for the analyses. A time effect indicated a significant change in patients' expectations or PSE over time, while a resolution effect indicated a significant difference in patients' expectations or PSE between those whose symptoms resolved and those whose did not. RESULTS: Patients' expectations (-3 to 3) increased over time (0.33/3 [0.19 to 0.77]). Overall expectations were higher for those who experienced symptom resolution based on the WORC (0.19/3 [0.05 to 0.33]). PSE increased over time (5.5/60 [3.6 to 7.4]). Overall PSE was higher for those who experienced symptom resolution based on the WORC (7.0 [3.9 to 10.1]) and the QuickDASH (4.9 [1.7 to 8.2]). CONCLUSION: Clinicians should consider monitoring PSE and patients' expectations as they are important indicators of outcome. CONTRIBUTION OF THE PAPER.

Right-sided Morgagni diaphragmatic hernia presenting as isolated left shoulder pain.

A woman in her 60s presented to the emergency department with excruciating, deep left shoulder pain and was found to have a right-sided Morgagni hernia, a rare type of congenital diaphragmatic hernia (CDH). She did not have chest pain, palpitations, shortness of breath, cough, abdominal pain, constipation, diarrhoea, nausea, vomiting or other symptoms classically associated with CDHs in adults. Laparoscopic robotic-assisted repair with mesh placement was performed, and the patient's recovery was uncomplicated, with no recurrence of shoulder pain. Our patient's presentation was unusual due to the absence of symptoms typically seen with CDHs in adults, and the presence of contralateral, left-sided shoulder pain with a right-sided Morgagni hernia.

Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis.

BACKGROUND: Rotator cuff tendinopathy (RCT) is a widespread musculoskeletal disorder and a primary cause of shoulder pain and limited function. The resulting pain and limited functionality have a detrimental impact on the overall quality of life. The purpose of this study was to perform a systematic review of the effects of extracorporeal shock wave therapy (ESWT) for RCT. METHODS: The literature search was conducted on the following databases from inception to February 20, 2024: PubMed, Web of Science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO, and China National Knowledge Infrastructure (CNKI) were checked to identify the potential studies exploring the effect of ESWT for the treatment of Rotator cuff tendinopathy (Calcification or non-calcification), control group for sham, other treatments (including placebo), without restriction of date, language. Two researchers independently screened literature, extracted data, evaluated the risk of bias in the included studies, and performed meta-analysis using RevMan 5.3 software. RESULTS: A total of 16 RCTs with 1093 patients were included. The results showed that compared with the control group, ESWT for pain score Visual Analogue Scale/Score (VAS) (SMD = -1.95, 95% CI -2.47, -1.41, P < 0.00001), function score Constant-Murley score (CMS) (SMD = 1.30, 95% CI 0.67, 1.92, P < 0.00001), University of California Los Angeles score (UCLA) (SMD = 2.69, 95% CI 1.64, 3.74, P < 0.00001), American Shoulder and Elbow Surgeons form (ASES) (SMD = 1.29, 95% CI 0.93, 1.65, P < 0.00001), Range of motion (ROM) External rotation (SMD = 1.00, 95% CI 0.29, 1.72, P = 0.02), Total effective rate (TER) (OR = 3.64, 95% CI 1.85, 7.14, P = 0.0002), the differences in the above results were statistically significant. But ROM-Abduction (SMD = 0.72, 95% CI -0.22, 1.66, P = 0.13), the difference was not statistically significant. CONCLUSION: Currently limited evidence suggests that, compared with the control group, ESWT can provide better pain relief, functional recovery, and maintenance of function in patients with RCT.

Measuring myofascial shear strain in chronic shoulder pain with ultrasound shear strain imaging: a case report.

BACKGROUND: Dysfunctional gliding of deep fascia and muscle layers forms the basis of myofascial pain and dysfunction, which can cause chronic shoulder pain. Ultrasound shear strain imaging may offer a non-invasive tool to quantitatively evaluate the extent of muscular dysfunctional gliding and its correlation with pain. This case study is the first to use ultrasound shear strain imaging to report the shear strain between the pectoralis major and minor muscles in shoulders with and without chronic pain. CASE PRESENTATION: The shear strain between the pectoralis major and minor muscles during shoulder rotation in a volunteer with chronic shoulder pain was measured with ultrasound shear strain imaging. The results show that the mean ± standard deviation shear strain was 0.40 ± 0.09 on the affected side, compared to 1.09 ± 0.18 on the unaffected side (p<0.05). The results suggest that myofascial dysfunction may cause the muscles to adhere together thereby reducing shear strain on the affected side. CONCLUSION: Our findings elucidate a potential pathophysiology of myofascial dysfunction in chronic shoulder pain and reveal the potential utility of ultrasound imaging to provide a useful biomarker for shear strain evaluation between the pectoralis major and minor muscles.