Effect Of Transcutaneous Electrical Nerve Stimulation Therapy On Pain And Functional Disability Level Among Patients With Rotator Cuff Disease- A Randomized Controlled Trial

Background: Shoulder pain is one of the leading causes of musculoskeletal pain and disability with rotator cuff disease was a common condition. The study aimed to assess the effect of TENS therapy on pain and functional disability level with rotator cuff disease patients. Methods: A parallel-group randomized controlled with 1:1 allocation, open-label, the trial is done at Orthopaedics and Physical Medicine and Rehabilitation Out Patient Departments, AIIMS, Rishikesh, Uttarakhand, India. After applying inclusion and exclusion criteria total of 76 patients (42 males,34 females) of rotator cuff disease were selected through total enumerative sampling, and block randomization with a block size of two is used to allocate treatments. The intervention was TENS therapy (high frequency (100Hz) with a pulse duration 120μsand low intensity (30- 40mA) for 20 minutes.) for consecutive five days plus standard treatment for the experimental group and standard treatment (Shoulder ROM, twice a day) as followed at AIIMS, Rishikesh to control group and Followed after completion of the treatment session. (after five days). SPADI scale is used for pain and functional disability level measurement. Results: A total of 70 patients (38 males and 32 females) were analyzed. The experimental and control group were homogenous in terms of total SPADI, disability and pain score (p>0.05). Median post-intervention total SPADI, disability and pain scores of the intervention group were significantly less as compared to the control group (p=0.000). No side- effects of treatment in any group. Conclusion: TENS therapy is an efficient therapy for patients experiencing rotator cuff disease Trial registration- CTRI/2018/09/015659

Prevalence Of Myofascial Dysfunctions In Breast Cancer Survivors

Background: After breast cancer treatment, many complications are seen in breast cancer survivors (BCS). In that musculoskeletal dysfunctions are common. These dysfunctions are one of the common sources of pain and disability. A recent study states that extreme pain after breast cancer treatment is often. Severe pain can be a source of a lot of limitations and psychological distress. Before the time assessment and rehabilitation can be inserted to reduce pain level, improve strength and mobility which will be helpful in minimize restrictions in daily living and improve quality of life (QOL). The objectives of the study were as follows: To determine the prevalence of myofascial dysfunctions in BCS. To study the association of myofascial dysfunctions and demographic variables in BCS. Methods: A total of 74 females who underwent breast cancer surgeries along with chemotherapy or radiotherapy or hormone therapy, were included based on inclusion criteria. Subjects were assessed for pectoralis tightness, postmastectomy pain syndrome (PMPS), rotator cuff diseases, adhesive capsulitis, lymphedema and axillary web syndrome (AWS) by using Visual Analogue Scale (VAS), Musculoskeletal Assessment and pectoral tightness test. Results: Primary outcomes used for the result were Musculoskeletal Assessment, Visual Analogue Scale, posture Assessment, pectoral tightness test. The most common type of myofascial dysfunctions was Pectoral tightness (p=0.1344), post-mastectomy pain syndrome (p=0.0116), rotator cuff disease (p= 0.1344), adhesive capsulitis (p= 0.9388) and axillary web syndrome (p= 0.9193) and the result was extremely significant. Conclusion: The major postoperative myofascial dysfunctions above the age of 50 years are pectoralis tightness, rotator cuff, and then by adhesive capsulitis and that of below 50 years was adhesive capsulitis followed by lymphedema and by rotator cuff disease.

The Most Common Shoulder Disorders

There are various different conditions that can lead to shoulder pain. The most common cause is rotator cuff disease, including impingement syndrome and rotator cuff tear. For satisfactory treatment outcome, it is important to understand the pathophysiology of rotator cuff disease and the treatment method must be based on these understandings. Frozen shoulder and calcific tendinitis are also common causes of shoulder pain. Because of self-healing abilities of these diseases, the treatment may be passive and neglected. However, without proper management, complications can remain, such as stiffness and pain. Even though various conservative treatments have yielded satisfactory results, surgical treatment should be considered if these have failed.

US Findings of Biceps Tendinitis: Cross Sectional Area Measurements of Long Head of Biceps Brachii

PURPOSE: The purpose of this study was to describe typical sonographic findings in patients with biceps tendinitis. MATERIALS AND METHODS: Seventy five patients who had been clinically diagnosed with biceps tendinitis were included. Of the 75, 37 were male, 38 were female, and their mean age was 56 +/- 9.74. The patients complained of shoulder pain and ultrasonography was performed for bilateral shoulders in all patients. The cross sectional area of the biceps tendon was measured. The status of fluid collection around the biceps tendon and accompanying rotator cuff disease were also investigated. RESULTS: The cross sectional areas of the diseased biceps tendon were 0.18 +/- 0.09 cm2 (range: 0.07-0.42), and the areas of the normal side was 0.11 +/- 0.05 cm2 (0.03-0.24). The cross sectional area of the diseased biceps tendon was 0.075 +/- 0.062 cm2 greater, on average, than the uninvolved site (p < 0.01). Thirty six patients (48%) had fluid collection around the inflamed biceps tendon, and 30 patients had accompanied rotator cuff disease. CONCLUSIONS: During US examination of the shoulder in patients complaining of shoulder pain, if the cross sectional area of the biceps tendon in the painful shoulder is asymmetrically and larger than the contralateral tendon, biceps tendonitis is suggested.

Gene Expression Profile Analysis by cDNA Array in the Subacromial Bursa of Patients with Rotator Cuff Disease / 대한정형외과학회잡지

PURPOSE: To examine the expression pattern of inflammatory cytokines/receptors in the subacromial bursa of patients with rotator cuff disease using a cDNA(Complement DNA) Array technique. MATERIALS AND METHODS: Twenty two human subacromial bursal specimens were obtained intraoperatively from patients during shoulder surgery (18 bursitis, 4 normal bursa). The RNA was isolated from the bursal tissues and the presence of gene expression was analyzed using a cDNA Array technique. The statistical differences between bursitis and the normal bursa specimens were determined using a Mann Whitney U test and Student's t-test. RESULTS: cDNA Array analysis revealed a significant increase in the expression of several cytokine genes and their receptors in patients with subacromial bursitis compared with the controls (p<0.05). These cytokines included the interleukins (IL-1, 6, 12, 13, 15, 16, 17) and their receptors, lymphotoxin, small inducible cytokines, chemokine receptor (CCR 4, 6, 7) and stromal cell derived factor-1 (SDF-1). CONCLUSION: This study demonstrated a significant increase in many inflammatory cytokines in the subacromial bursa of patients with rotator cuff disease. This suggests that there is an active inflammatory reaction at the subacromial bursa in rotator cuff disease.

Home Treatment of Rotator Cuff Disease / 대한정형외과학회잡지

We treated 617 patients who were diagnosed as rotator cuff disease at the Department of Orthopaedic Surgery, Asan Medical Center in Korea between March, 1995 and December, 1996. We evaluated 175 cases who were followed up over five months and were treated according to our home treatment protocol. Average follow-up period was eleven months(range, five to eighteen months). We educated every patient who were not suspected of having full thickness tear of the rotator cuff based on clinical and MRI findings. According to patients condition, we treated them with both stretching and strengthening exercise or strengthening exercise only. This physician-directed home treatment was occasionally supported by the use of NSAID in case severe pain. Patients did stretching and strengthening exercise in 93(53%)cases, and strengthening exercise initially in 82(47%)cases. One hundred and forty five(83%) cases had satisfactory results. Home treatment of the rotator cuff disease is effective, convenient and not dangerous. We recommend this physiciandirected home treatment for primary management of almost all the patient with rotator cuff disease except full thickness tear of the rotator cuff tendon.