RESUMEN
¼ Pain in the shoulder is a common orthopaedic complaint that can be caused by shoulder or neck pathologies.¼ Shoulder and neck pathologies often coexist, among which one may be a predisposing factor for the other.¼ History, physical examination, and diagnostic injections can be used to discern the cause of shoulder pain and guide treatment.
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Articulación del Hombro , Hombro , Humanos , Vértebras Cervicales/patología , Dolor de Hombro/diagnóstico , Dolor de Hombro/etiología , Dolor de Hombro/patología , Examen FísicoRESUMEN
Adhesive capsulitis, colloquially known as "frozen shoulder," is a relatively common disorder, affecting approximately 2% to 5% of the general population. The incidence may be higher as the condition can be relatively mild and self-limited and thus many patients who experience it may never present for treatment. It involves a pathologic process of gradual fibrosis of the glenohumeral joint that leads to limited active and passive range of motion, contracture of the joint capsule, and shoulder pain.
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Bursitis , Articulación del Hombro , Humanos , Rango del Movimiento Articular , Bursitis/terapia , Bursitis/complicaciones , Articulación del Hombro/patología , Cápsula Articular/patología , Dolor de Hombro/etiología , Dolor de Hombro/terapia , Dolor de Hombro/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Partial-thickness rotator cuff tears are commonly found in the articular-side tendon of the supraspinatus; however, isolated lesions, except those occurring in the supraspinatus tendons, are rare. We report three cases of isolated bursal-side infraspinatus tears that were difficult to detect by magnetic resonance imaging but could be visualized by computed tomography bursography. CASE PRESENTATION: Three Asian patients (59-71 years old) with shoulder pain ranging from 1 month to 3 years in duration were each diagnosed with shoulder impingement syndrome. Magnetic resonance imaging studies failed to show a tear of the rotator cuff tendon complex. However, computed tomography bursography showed a longitudinal infraspinatus partial-thickness tear on the bursal side in each case. Arthroscopic decompression of the subacromial space and debridement of the infraspinatus tendon tear successfully alleviated the shoulder pain in two of the three patients; the third patient did not undergo surgery and remained symptomatic at follow-up. CONCLUSIONS: In patients with chronic shoulder pain but normal magnetic resonance imaging findings, computed tomography bursography should be considered, as bursal-side infraspinatus tears may be found in these patients. Furthermore, our findings provide a basis for larger studies to further establish the accuracy of computed tomography bursography for these lesions.
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Laceraciones , Lesiones del Manguito de los Rotadores , Anciano , Artroscopía/métodos , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/patología , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/cirugía , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/etiología , Dolor de Hombro/patología , Tomografía Computarizada por Rayos XAsunto(s)
Calcinosis/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Dolor de Hombro/diagnóstico por imagen , Adulto , Calcinosis/complicaciones , Calcinosis/patología , Diagnóstico Diferencial , Femenino , Humanos , Ilustración Médica , Lesiones del Manguito de los Rotadores/complicaciones , Lesiones del Manguito de los Rotadores/patología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/patología , Dolor de Hombro/etiología , Dolor de Hombro/patologíaRESUMEN
BACKGROUND: Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the morphometric structures in the shoulder joint make it easier to explain the cause of the various shoulder problems. The objective of this study is putting emphasis on the importance of acromion types, os acromiale presence and acromial morphometric measurements in the aetiology and diagnosis of shoulder pain. MATERIALS AND METHODS: A retrospective study, based on 100 patients of both genders who presented with the complaints of shoulder pain and underwent magnetic resonance imaging, was conducted. Within this scope, types of acromion, slope of acromion, length of acromion, length of coracoid process, the distance between acromion and coracoid process, lateral acromial angle (LAA), critical shoulder angle (CSA), acromial index (AI) and acromiohumeral distance were measured. The data were analysed considering the gender and acromion types and the presence of os acromiale is investigated. RESULTS: The most common acromion was type II (curved) (frequency rate 62%) while the rate of type I (flat) and type III (hooked) acromions were 21% and 17%, respectively. The length of acromion and coracoid process were found to be significantly longer in males, while no significant difference between genders in terms of the distance between acromion and coracoid process were observed. Furthermore, while negative correlation between LAA and AI as well as LAA and CSA were observed; positive correlation between AI and CSA was found. In addition, there was negative correlation between slope of acromion and acromiohumeral distance. Besides, acromiohumeral distance was significantly higher in males. Regarding the presence of os acromiale, it was observed in 3 women out of 59 and 2 men out of 41, which indicated no significant difference between genders. CONCLUSIONS: It is evaluated that the morphometric measurement is of importance in contributing clinically in distinguishing the problems that may occur according to gender and acromion types.
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Dolor de Hombro , Hombro , Femenino , Humanos , Masculino , Hombro/diagnóstico por imagen , Estudios Retrospectivos , Dolor de Hombro/patología , Acromion/diagnóstico por imagen , Acromion/patología , Escápula/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Shoulder morbidity following breast cancer treatment is multifactorial. Despite several treatment- and patient-related factors being implicated, unexplained inter-individual variability exists in the development of such morbidity. Given the paucity of relavant genetic studies, we investigate the role of polymorphisms in candidate proteoglycan genes. PATIENTS AND METHODS: We conducted a cross-sectional study on 254 South African breast cancer survivors, to evaluate associations between shoulder pain/disability and ten single nucleotide polymorphisms (SNPs) within four proteoglycan genes: ACAN (rs1126823 G>A, rs1516797 G>T, rs2882676 A>C); BGN (rs1042103 G>A, rs743641 A>T, rs743642 G>T); DCN rs516115 C>T; and VCAN (rs11726 A>G, rs2287926 G>A, rs309559). Participants were grouped into no-low and moderate-high shoulder pain/disability based on total pain/disability scores: < 30 and ≥ 30, respectively using the Shoulder Pain and Disability Index (SPADI). RESULTS: The GG genotype of VCAN rs11726 was independently associated with an increased risk of being in the moderate-to-high shoulder pain (P = 0.005, OR = 2.326, 95% CI = 1.259-4.348) or disability (P = 0.011, OR = 2.439, 95% CI = 1.235-4.762) categories, after adjusting for participants' age. In addition, the T-T-G inferred allele combination of BGN (rs74364-rs743642)-VCAN rs11726 was associated with an increased risk of being in the moderate-to-high shoulder disability category (0 = 0.002, OR = 2.347, 95% CI = 1.215-4.534). CONCLUSION: Our study is first to report that VCAN rs11726, independently or interacting with BGN polymorphisms, is associated with shoulder pain or disability in breast cancer survivors. Whereas our findings suggest an involvement of proteoglycans in the etiology of shoulder pain/disability, further studies are recommended.
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Neoplasias de la Mama/genética , Predisposición Genética a la Enfermedad , Dolor de Hombro/genética , Versicanos/genética , Adulto , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/patología , Supervivientes de Cáncer , Estudios Transversales , Personas con Discapacidad , Femenino , Estudios de Asociación Genética , Genotipo , Humanos , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Dolor de Hombro/complicaciones , Dolor de Hombro/patologíaAsunto(s)
Artritis Reumatoide/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Dolor de Hombro/diagnóstico por imagen , Artritis Reumatoide/patología , Humanos , Inflamación/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Articulación del Hombro/patología , Dolor de Hombro/patologíaRESUMEN
BACKGROUND: Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location of sensory nerve branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches (ABs) (1) innervating the shoulder joint and (2) the distribution of sensory receptors about its capsule and bursae. MATERIALS AND METHODS: Four electronic databases were queried, between January 1945 and June 2019. Thirty original articles providing a detailed description of the distribution of sensory receptors about the shoulder joint capsule (13) and its ABs (22) were reviewed. RESULTS: The suprascapular, lateral pectoral, axillary, and lower subscapular nerves were found to provide ABs to the shoulder joint. The highest density of nociceptors was found in the subacromial bursa. The highest density of mechanoreceptors was identified within the insertion of the glenohumeral ligaments. The most frequently identified innervation pattern comprised 3 nerve bridges (consisting of ABs from suprascapular, axillary, and lateral pectoral nerves) connecting the trigger and the identified pain generator areas rich in nociceptors. CONCLUSION: Current literature supports the presence of a common sensory innervation pattern for the human shoulder joint. Anatomic studies have demonstrated that the most common parent nerves supplying ABs to the shoulder joint are the suprascapular, lateral pectoral, and axillary nerves. Further studies are needed to assess both the safety and efficacy of selective denervation of the painful shoulders, while limiting the loss of proprioceptive function.
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Bolsa Sinovial/inervación , Cápsula Articular/inervación , Sistema Nervioso Periférico/anatomía & histología , Células Receptoras Sensoriales , Articulación del Hombro/inervación , Humanos , Dolor de Hombro/etiología , Dolor de Hombro/patologíaRESUMEN
Identification of anatomical variations is essential to understand and perfectly manage the correlated clinical disorders. One of such disorders is shoulder pain that might result from entrapment of suprascapular nerve at the narrow supracondylar foramen. In this article, we report a rare case of absence of such foramen. With absence of the foramen, there is an increasing potentiality of nerve entrapment beneath the superior scapular transverse ligament. Therefore, investigation of such anatomical variation is suggested for proper management of cases of shoulder pain and dysfunction
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Humanos , Escápula/anatomía & histología , Variación Anatómica , Síndromes de Compresión Nerviosa/patología , Escápula/patología , Dolor de Hombro/patología , Ligamentos Articulares/patología , Articulación del Hombro/patologíaRESUMEN
PURPOSE: This study aimed to identify the effects of myofascial pain syndrome on shoulder pain, range of motion, and body composition around the shoulder in middle-aged women. METHODS: A total of 72 women participated in the randomized controlled trial. The subjects were grouped into an experimental group (n=39) and a control group (n=33). The experimental group received a resistance exercise program using an elastic band for 8 weeks, 3 days a week. The control group followed a normal daily for 8 weeks. Measurements were conducted three times; before the experimental treatment (pre-test), the 2nd and 8th weeks after treatment. RESULTS: Regarding the general characteristics and homogeneity of the dependent variables, there were no significant differences between the two groups, except for the thickness of the left and right muscles and the left fat. After treatment, shoulder pain was significantly different between the two groups (F=18.54, p<.001) and the range of shoulder motion was significantly different (left, F=86.70, p<.001; right, F=98.66, p<.001). Furthermore, there were a significant differences in the thickness of muscles between the two groups (left, F=40.20, p<.001; right, F=29.57, p<.001); however, the thickness of fat was not significantly different. CONCLUSION: The resistance exercise program reduces shoulder pain and improves the range of motion of the shoulder joint and increases muscle mass on around the shoulder. It suggests to conduct a study to confirm the long-term exercise effect.
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Terapia por Ejercicio , Síndromes del Dolor Miofascial/terapia , Dolor de Hombro/patología , Hombro/fisiología , Composición Corporal , Femenino , Humanos , Persona de Mediana Edad , Músculo Esquelético/fisiología , Síndromes del Dolor Miofascial/patología , Rango del Movimiento Articular , Entrenamiento de Fuerza , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Common types of musculoskeletal conditions include pain in the neck and shoulder areas. This study seeks to identify the genetic variants associated with neck or shoulder pain based on a genome-wide association approach using 203 309 subjects from the UK Biobank cohort and look for replication evidence from the Generation Scotland: Scottish Family Health Study (GS:SFHS) and TwinsUK. METHODS: A genome-wide association study was performed adjusting for age, sex, BMI and nine population principal components. Significant and independent genetic variants were then sent to GS:SFHS and TwinsUK for replication. RESULTS: We identified three genetic loci that were associated with neck or shoulder pain in the UK Biobank samples. The most significant locus was in an intergenic region in chromosome 17, rs12453010, having P = 1.66 × 10-11. The second most significant locus was located in the FOXP2 gene in chromosome 7 with P = 2.38 × 10-10 for rs34291892. The third locus was located in the LINC01572 gene in chromosome 16 with P = 4.50 × 10-8 for rs62053992. In the replication stage, among four significant and independent genetic variants, rs2049604 in the FOXP2 gene and rs62053992 in the LINC01572 gene were weakly replicated in GS:SFHS (P = 0.0240 and P = 0.0202, respectively). CONCLUSIONS: We have identified three loci associated with neck or shoulder pain in the UK Biobank cohort, two of which were weakly supported in a replication cohort. Further evidence is needed to confirm their roles in neck or shoulder pain.
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Factores de Transcripción Forkhead/genética , Dolor de Cuello/genética , ARN Largo no Codificante/genética , Dolor de Hombro/genética , Bancos de Muestras Biológicas , Femenino , Predisposición Genética a la Enfermedad , Estudio de Asociación del Genoma Completo , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/epidemiología , Dolor de Cuello/patología , Polimorfismo de Nucleótido Simple/genética , Dolor de Hombro/epidemiología , Dolor de Hombro/patología , Reino Unido/epidemiología , Población Blanca/genéticaRESUMEN
We report the case of a 27-year-old woman who underwent an F-FDG PET/CT, after administration of 20 mg propranolol, 20 minutes preinjection, to investigate B-symptoms as well as right-sided shoulder pain. Unilateral hypermetabolism was seen in the left cervical, thoracic, and paravertebral brown fat, without any uptake on the contralateral side. The patient was born with neuroblastoma in the right thoracic area. She underwent surgery a few days after birth. As brown fat activation is under sympathetic control, we hypothesize that a surgical lesion to the right orthosympathetic trunk resulted in sympathetic denervation, responsible for this distribution.
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Tejido Adiposo Pardo/diagnóstico por imagen , Tejido Adiposo Pardo/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Femenino , Fluorodesoxiglucosa F18 , Humanos , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/patologíaRESUMEN
Objectives: To investigate the severity and effect on quality of life (QOL) of various types of pain in healthy volunteers.Methods: A total of 384 subjects (male: 158, female: 226, average age: 63 years) were included in a prospective cohort study (Yakumo study). Shoulder pain, low back pain (LBP), sciatica, knee pain, and the American Shoulder and Elbow Surgeons (ASES) shoulder score were evaluated with SF-36.Results: The prevalence of shoulder pain, LBP, sciatica, and knee pain was 42%, 44%, 16%, and 48%, respectively, with similar severities of pain. Shoulder pain visual analogue scale (VAS) and ASES shoulder scores were significantly correlated with SF-36 domains. Subjects with poor physical QOL had significantly higher VAS scores for all pain types and a lower ASES shoulder score. Shoulder pain VAS was also significantly related to poor mental QOL. Multivariate regression analysis adjusted for age and gender showed that shoulder pain VAS (OR: 1.25, p < .05) and 10-m gait speed (OR: 1.82, p < .05) were significant independent risk factors for poor physical QOL.Conclusion: Only shoulder pain of similar severity to other pain and shoulder complaints impacted on both physical and mental QOL. The severity of shoulder pain was an independent risk factor for poor physical QOL.
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Dolor Musculoesquelético/epidemiología , Calidad de Vida , Dolor de Hombro/epidemiología , Anciano , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Dolor Musculoesquelético/clasificación , Dolor Musculoesquelético/patología , Prevalencia , Dolor de Hombro/patologíaRESUMEN
PURPOSE: Shoulder complaints are an important reason for inability to work. There are few considerations that link the effect of kind of therapy with ability to work in connection with kind of employment. This prospective, comparative clinical follow-up study examines the influence of occupational activity with conservative and operative therapy on the outcome of therapy in terms of function, pain and ability to work. METHODS: In this study, 97 patients (women: n=22, men: n=75, mean age: 43.1±10.1 years) with a primary extrinsic shoulder impingement syndrome were included. Patients were divided into blue and white collar workers. Further on the subgroups of conservative and operative therapy were considered. Either a sole conservative therapy or an operative therapy with physiotherapeutic follow-up treatment took place. The conservative therapy was carried out as a structured re-coordination of muscles of the shoulder girdle under supervision of a physiotherapist. In the surgical cohorts an arthroscopic subacromial decompression was performed. Follow-up examinations were passed 3, 6 and 12 months after starting the intervention. Function (Constant Score), pain (NRS) and the duration of inability to work were assessed. The statistical analysis was performed using mixed-design ANOVA to calculate main effect and interactions (therapy*kind of employment*time) adjusted with age, sex and body mass index. RESULTS: There was no statistically significant difference in terms of function and pain between blue and white collar workers. Office workers showed a significantly longer inability to work 3 months after surgical treatment compared with conservative treatment (7.3±0.8 weeks vs. 0.5±7.3 weeks; p<0.001). Further the group of white collars with operative therapy was significantly longer inable to work than the group of blue collar workers after operative therapy 3 months after surgical treatment (3.0±1.1 weeks vs. 7.3±0.8 weeks; p=0.002). CONCLUSION: On the one hand, working in an office could be seen as a negative predictor for durance of inability to work. On the other hand, surgical treatment itself was a negative predictor for the durance of inability to work. Furthermore, no difference between conservative and surgical therapy could be observed in function and pain one year after starting the treatment.
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Artroscopía , Descompresión Quirúrgica/métodos , Ocupaciones , Síndrome de Abducción Dolorosa del Hombro/rehabilitación , Síndrome de Abducción Dolorosa del Hombro/cirugía , Dolor de Hombro/cirugía , Adulto , Femenino , Estudios de Seguimiento , Alemania , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Dolor de Hombro/patología , Resultado del TratamientoAsunto(s)
Traumatismos en Atletas/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Dolor de Hombro/diagnóstico por imagen , Traumatismos en Atletas/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/patología , Lesiones del Manguito de los Rotadores/etiología , Lesiones del Manguito de los Rotadores/patología , Dolor de Hombro/etiología , Dolor de Hombro/patología , Deportes , Adulto JovenRESUMEN
OJECTIVE: Clinical consequences of ectopic tendons of the pectoralis minor muscle (PMM) for shoulder pain and range-of-motion limitation have been demonstrated. For better understanding the existence of such ectopic tendons, a phylogenetic hypothesis is proposed. METHODS: Forty-five shoulders of anatomical specimens were dissected and examined. Insertions areas of PMM were measured and occurring aberrant tendons were identified. Their relationship with the coracohumeral ligament (CHL) described and samples of the ligament were collected and histologically stained. RESULTS: The prevalence of PMM variations was 37.84%. Shoulders with variations showed a statistically significant smaller coracopectoral distance (p<0.001) and larger insertion areas (p<0.003) than shoulders without. A strong negative correlation between these two variables (p<0.001, r = -0.620) was shown. CONCLUSIONS: The presented results prompted the conclusion that the CHL may be in fact the remnant of the pectoralis minor tendon (PMT), which migrated from the humerus to the coracoid process through the process of phylogenetic evolution. Variations of PMTs are significantly more common than in previous studies. Imaging techniques appear to be insufficiently sensitive for reliably detecting ectopic tendons. Especially in patients experiencing shoulder pain and stiffness in whom the commoner pathologies have been ruled out the possibility of ectopic PMT should be kept in mind and ruled out.
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Coristoma/complicaciones , Ligamentos Articulares , Músculos Pectorales , Rango del Movimiento Articular/fisiología , Dolor de Hombro/etiología , Anciano , Anciano de 80 o más Años , Autopsia , Coristoma/patología , Femenino , Humanos , Artropatías/etiología , Artropatías/patología , Artropatías/fisiopatología , Masculino , Filogenia , Articulación del Hombro/patología , Articulación del Hombro/fisiopatología , Dolor de Hombro/patología , Dolor de Hombro/fisiopatologíaRESUMEN
INTRODUCTION: The long head of the biceps (LHB) is often resected in shoulder surgery. However, its contribution to inflammatory processes in the shoulder remains unclear. In the present study, inflamed and noninflamed human LHBs were comparatively characterized for features of inflammation. MATERIALS AND METHODS: Twenty-two resected LHB tendons were classified into inflamed ( n = 11) and noninflamed ( n = 11) samples. For histological examination, samples were stained with hematoxylin eosin, Azan, van Gieson, and Masson Goldner trichrome. Neuronal tissue was immunohistochemically visualized. In addition, specific inflammatory marker gene expression of primary LHB-derived cell cultures were analyzed. RESULTS: Features of tendinopathy, such as collagen disorganization, infiltration by inflammatory cells, neovascularization, and extensive neuronal innervation were found in the tendinitis group. Compared to noninflamed samples, inflamed LHBs showed a significantly increased inflammatory marker gene expression. CONCLUSION: Structural and biomolecular differences of both groups suggest that the LHB tendon acts as an important pain generator in the shoulder joint. These findings can, on the one hand, contribute to the understanding of the biomolecular genesis of LHB tendinitis and, on the other hand, provide possibilities for new therapeutic approaches.
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Articulación del Hombro , Dolor de Hombro/etiología , Dolor de Hombro/patología , Tendinopatía/complicaciones , Tendinopatía/patología , Adulto , Anciano , Anciano de 80 o más Años , Artroscopía , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/patología , Dolor de Hombro/cirugía , Tendinopatía/cirugíaRESUMEN
BACKGROUND: Rounding of the posterior glenoid rim is observed in young throwing athletes with internal shoulder impingement and is considered developmental dysplasia of the glenoid. The aim of our study was to determine the incidence rate of dysplastic changes of the glenoid within a group of 92 young baseball players. METHODS: The study group included 92 male baseball players, with a mean age of 14.63 years. Of these patients, 30 were diagnosed with Little Leaguer's shoulder and 62 with a painful baseball-throwing shoulder with no abnormal findings on x-ray. The posterior glenoid rim of the affected shoulder was compared with the contralateral nonpainful shoulder, with the 2 following outcomes measured on radiographs obtained using the modified Bernageau imaging method: the distance between the anterior and posterior glenoid rims and the presence or absence of dysplasia of the posterior glenoid rim. RESULTS: The mean distance between the anterior and posterior glenoid rims was significantly shorter in the painful shoulders (mean, 26 mm) than in the nonpainful shoulders (mean, 29 mm; P < .0001). Dysplasia of the posterior glenoid rim was identified in 89 painful shoulders (96.7%), with 9 cases (9.7%) identified on the unaffected contralateral side (P < .001). The presence of dysplasia was not correlated with the age at which baseball playing began. CONCLUSION: The incidence of dysplasia of the posterior glenoid rim is high (96.7%) among young baseball players with a painful shoulder. The identified dysplasia may be related to impaired development of the inferior peripheral secondary glenoid ossification center due to repetitive throwing.
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Béisbol/lesiones , Enfermedades Óseas/epidemiología , Enfermedades Óseas/patología , Escápula/patología , Dolor de Hombro/etiología , Dolor de Hombro/patología , Adolescente , Factores de Edad , Enfermedades Óseas/diagnóstico por imagen , Niño , Humanos , Incidencia , Masculino , Radiografía , Estudios Retrospectivos , Escápula/diagnóstico por imagen , Dolor de Hombro/diagnóstico por imagenRESUMEN
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