Spinal manipulation does not improve short-term pain and function in persons with painful shoulder: a systematic review with meta-analysis.

PURPOSE: To investigate the benefit of spinal high-velocity low-amplitude thrust (HVLAT) in improving pain and disability in persons with painful shoulder as primary outcomes. Function, quality of life, persons (and clinicians) satisfaction, adverse events rate, and time for recovery were secondary outcomes. METHODS: A systematic review with meta-analysis was conducted and MEDLINE, CENTRAL, Embase, and PEDro until 20 September 2023 were investigated. Two thousand eight hundred and ninety-nine records were retrieved and nine studies were included. Risk of bias of included studies was assessed through the Revised Cochrane risk-of-bias tool. The certainty of evidence of the pooled results was graded with GRADE approach. RESULTS: The analysis included nine studies (441 persons). The pooled results showed non-significant differences between HVLAT versus sham in pain at pre-post follow-up (MD -0.13, 95% confidence interval (CI) -0.60; 0.35; p = 0.61, I2 = 0%), and at <4 days follow-up (SMD 0.16, 95%CI -0.16; 0.48; p = 0.34, I2 = 23%); in function at <4 days follow-up (SMD -0.29, 95%CI -0.69; 0.11; p = 0.16, I2 = 50%). The certainty of evidence ranged from low to very low. CONCLUSIONS: HVLAT was not more effective than sham in improving pain and function at pre-post and at <4 days follow-up. When used as an "add-on technique", HVLAT did not improve pain nor disability.

High-velocity low-amplitude thrust (HVLAT) manipulation is no more effective than sham in improving shoulder pain at pre-post follow-up.Clinician should not be recommended to deliver HVLAT manipulation in subjects with painful shoulder with the purpose of reducing pain intensity.However, HVLAT manipulation should be considered within a multimodal approach to address function in painful shoulder subjects.

Effectiveness of electrophysical agents in subjects with frozen shoulder: a systematic review and meta-analysis.

PURPOSE: This systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS). METHODS: A thorough search of MEDLINE, Cochrane Library, PEDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through Cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: The analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. The certainty of evidence was very low. CONCLUSIONS: Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings.

Although a clinical difference in pain and disability was observed, the certainty of the evidence was low.Ultrasound therapy is not recommended in patients with frozen shoulder.Electrophysical agents may not ensure adequate therapeutic efficacy.

Depression, fear of re-injury and kinesiophobia resulted in worse pain, quality of life, function and level of return to sport in patients with shoulder instability: a systematic review.

INTRODUCTION: Maladaptive psychological responses may hinder participation and return to pre-injury level in sport. The aim of this study was to investigate the psychological factors influence on pain, function, quality of life and time to return to sport in subjects with shoulder instability. EVIDENCE ACQUISITION: The research was conducted until the 15th of May 2022 in MEDLINE, CENTRAL, PEDro, and PubPSYCH regardless language, publication status or date. We included adults (≥16 years old) with shoulder instability. Quality assessment was performed using Joanna Briggs Institute Critical Appraisal tools. EVIDENCE SYNTHESIS: Three papers, 270 participants, met the inclusion criteria. Subjects with preoperative depression demonstrated worse 1-year postoperative shoulder-related quality of life score than the cohort without depression. Shoulder function had a weak negative correlation with depression. Pain intensity and depression showed a positive correlation of moderate strength. Fear of re-injury correlated with SPADI total, pain and function; moreover, it increased the likelihood of recurrent dislocation in multivariate analysis. Kinesiophobia at baseline correlated with WOSI. CONCLUSIONS: Depression, fear of re-injury and kinesiophobia correlate with pain, function, quality of life and return to sport in people with shoulder instability. We recommend a multi-professional approach to integrate the psychological standpoint in rehabilitation treatment to maximize quality of life and function in subjects with instability.

[Conservative treatment of tendinopathies of upper limbs in occupational health: a literature review]. / Trattamenti conservative nelle tendinopatie agli arti superiori in ambito occupazioinale: revision narrative.

BACKGROUND: In the last few years, the incidence of upper limbs tendon injuries has seen a dramatic increase among workers. Conservative treatment is the first choice to relieve symptoms, allowing a safe return to work. However, the scientific evidence of its  efficacy is widely debated. OBJECTIVE AND METHODS: Research and literature review on the efficacy of conservative treatment of upper limbs tendon injuries in occupational settings. RESULTS: A total of 271 references were found on Medline and Embase up to May 2015. 116 papers were excluded, 155 articles were included and the full text read. CONCLUSIONS: After a timely diagnosis, a prompt start of the rehabilitation programme and a limitation of complete rest are useful to relieve pain, increase functionality and reduce work absenteeism in the long term. Conservative treatment combinations, such as manual therapy, specific exercises focused on increasing flexibility and muscle strength and specific-gesture training, achieves more significant results than a single isolated treatments. Currently, there is no strong scientific evidence to support prolotherapy and Platelet-Rich Plasma (PRP). However, current promising results will encourage further studies. Awareness among both employers and employees about prevention and risk factors should be enhanced.