Prevalencia de dolor de hombro y sus factores asociados en lesionados medulares parapléjicos usuarios de silla de ruedas / Shoulder pain prevalence and associated factors in spinal cord-injured paraplegic wheelchair users

INTRODUCCIÓN: la prevalencia de dolor de hombro en pacientes parapléjicos usuarios de silla de ruedas es elevada. existe consenso en que el uso de la silla de ruedas manual es un factor importante en el origen de este dolor. no existen estudios en Chile acerca del tema. OBJETIVO: determinar la prevalencia y factores asociados a dolor de hombro en personas con paraplejia secundaria a lesión medular traumática, usuarios de sillas de ruedas, describiendo también las características del dolor. MATERIALES Y MÉTODOS: estudio descriptivo transversal en personas adultas con paraplejia secundaria a lesión medular traumática, que cumplieron los criterios de inclusión. previo consentimiento informado, se les aplicó un cuestionario ISCIPDS:B, enfocado a dolor de hombro. además de preguntar qué tipo de silla de ruedas utilizan, tiempo de autopropulsión, uso de guantes de propulsión y ocupación previa a la lesión medular. se recuperaron datos de registros en ficha clínica para identificar sexo, edad, fecha del accidente, ASIA impairment scale (AIS) y nivel neurológico de la lesión. RESULTADOS: 59 pacientes cumplieron los criterios de inclusión. de ellos, el 61% de ellos refirió dolor en hombro (s). no hubo una asociación estadísticamente significativa entre el dolor en el hombro y la edad, tiempo de evolución de lesión medular, AIS, nivel de lesión neurológica, tipo de silla de ruedas ni el tiempo de uso de la silla de ruedas manual. hubo una asociación estadísticamente significativa entre uso de guantes de propulsión y el dolor de hombro. la afectación bilateral es más frecuente que unilateral. el dolor promedio fue de NRS 5,6. la duración fue referida principalmente como constante, mayor a 1 hora pero menor a 24 horas. la mayor intensidad de dolor se reportó como vespertina. CONCLUSIONES: la prevalencia de dolor de hombro en pacientes chilenos con paraplejia secundaria a lesión medular traumática es alta. es necesaria mayor investigación para determinar si los hallazgos de este estudio se extrapolan a la población general con lesión medular traumática.

INTRODUCCIÓN: the prevalence of shoulder pain in paraplegic patients using wheelchair is high. there is consensus that the use of manual wheelchair is an important factor in the origin of this pain. there are no studies in Chile about this. OBJECTIVE: to determine the prevalence and factors associated with shoulder pain in paraplegic patients for traumatism with spinal cord injury (SCI) wheelchair users, also describing the characteristics of pain. MATERIALS AND METHODS: descriptive transversal study in adults paraplegic patients for traumatism with SCI, who met inclusion criteria. an ISCIPDS:B questionnaire was previously informed, focused on shoulder pain, also asking what kind of wheelchair is being used, time of propulsion, use of propulsion gloves, and if it was being used before the spinal cord injury. further clinical record data were retrieved to identify gender, age, date of accident, ASIA, and neurological injury level. RESULTS: 59 patients met the inclusion criteria, 61% of them reported shoulder pain. there was no statistically significant association between shoulder pain and age, duration of SCI, ASIA, neurological level of injury, type of wheelchair, nor usage time of the manual wheelchair. there was a statistically significant association between the use of gloves propulsion and shoulder pain. bilateral involvement is more often. the average pain was NRS 5.6. the duration was mainly referred as a constant greater than 1hour but less than 24hours. the greater intensity of pain was reported during the evening. CONCLUSIONS: the prevalence of shoulder pain in chilean paraplegic for spinal cord traumatic injury is high. more research is needed to determine whether the findings of this study are extrapolated to the general population.

Dolor musculoesquelético y condiciones percibidas de trabajo en médicos y enfermeras de un hospital de Lima, Perú / Musculoskeletal Dolor y condiciones de trabajo en percibidas medical enfermeras y un hospital in Lima, Peru

Introducción: Los factores psicosociales y ergonómicos interactúan generando dolor musculoesquelético, frecuente en trabajadores de salud. Existen pocos estudios relacionando ambas condiciones, especialmente en médicos. Objetivo: Examinar la asociación entre factores psicosociales de estrés laboral (modelos demanda-control-apoyo (DC) y desequilibrio esfuerzo/recompensa (ERI)) y dolor musculoesquelético en médicos y enfermeras de un hospital público de Lima, Perú. Diseño: Estudio transversal con cuestionarios autorreportados anónimos: datos sociodemográficos, Cuestionario Nórdico (dolor musculoesquelético) y cuestionarios JCQ (Karasek) y ERI (Siegrist), en 54 médicos y 48 enfermeras del Hospital “San Juan Bautista” Huaral en el año 2013. Resultados: Los médicos varones presentaron un IMC medio de 28,45 y la media de horas trabajadas semanales fue de 66,86 (valores superiores a los de médicos mujeres y enfermeras). La prevalencia global de dolor musculoesquelético fue 93,1 por cento, más frecuente en cuello (72,5 por cento), hombros (46,1 por cento), muñecas y manos (44,1 por cento), dorso (52 por cento) y región lumbar (51 por cento). El dolor interfirió con las actividades en 53,9 por cento. Las enfermeras reportaron más regiones corporales afectadas por dolor (1,71 vs 0,98, p = 0,036). Hubo asociación entre dorsalgia y desequilibrio esfuerzo/recompensa (médicos: OR = 4,91, IC 95 por cento: 1,32-18,22; enfermeras: OR = 5,58 e IC 95 por cento: 1,09-28,45). Conclusiones: La prevalencia de dolor musculoesquelético, en especial cervical, dorsal y lumbar, es elevada, similar a otros reportes. Las dimensiones del modelo ERI se asociaron con dolor en cuello, hombros, dorsalgia y lumbago...

Background: Psychosocial and ergonomic factors interaction generates musculoskeletal pain, common in health care workers. There are few studies relating both conditions, especially in physicians. Objective: To evaluate the association between psychosocial factors of work stress (demand-control-support (DC) and effort-reward imbalance (ERI) models) and musculoskeletal pain on physicians and nurses from a public hospital at Lima, Peru. Design: Observational cross-sectional study employing anonymous questionnaires: socio-demographic data, Nordic Questionnaire (for musculoskeletal pain), and psychometric inventories for psychosocial factors: JCQ (Karasek) and ERI (Siegrist) on 54 physicians and 48 nurses from the Hospital San Juan Bautista Huaral at 2013. Results: Male physicians were overweight more frequently and worked more hours per week, without showing association with pain. Musculoskeletal pain prevalence was 93.1 per cent, with significant pain in 53.9 per cent of the cases. The most frequently affected sites were neck (72.5 per cent), shoulders (46.1 per cent), wrists and hands (44.1 per cent), upper back (52 per cent) and low back (51 per cent). Nurses reported more affected regions (1.71 vs. 0.98, p = 0.036). It was seen a significant association between upper back pain and the effort / reward coefficient (physicians: OR = 4.91, IC 95 per cent: 1.32-18.22; nurses: OR = 5.58, IC 95 per cent: 1.09-28.45). Conclusions: Reported prevalence of musculoskeletal pain, specially cervical, dorsal and lumbar is high and similar to other reports. The dimensions of the ERI model have shown a better association with neck pain, shoulder pain and upper/lower back pain presentation...

Introdução: Os fatores psicossociais e ergonômicos interagem gerando dor musculoesquelética, freqüente em trabalhadores de saúde. Existem poucos estudos que relacionam as duas condições, especialmente em médicos. Objetivo: Examinar a associação entre fatores psicossociais de estresse laboral (modelos demanda - controle - apoio (DC) e desequilíbrio esforço / recompensa (ERI)) e dor musculoesquelética em médicos e enfermeiras de um hospital público de Lima, Peru. Desenho: Estudo seccional com questionários auto-reportados anônimos: dados sócio-demográficos, Questionário Nórdico (dor musculoesquelética) e questionários JCQ (Karasek) e ERI (Siegrist), em 54 médicos e 48 enfermeiras do Hospital “San Juan Bautista” Huaral no ano 2013. Resultados: Os médicos varões apresentaram um IMC médio de 28,45 e a média de horas laboradas semanais foram 66,86 (valores superiores aos dos médicos mulheres e enfermeiras). A prevalência global da dor musculoesquelética foi 93,1 por cento, mais freqüente em pescoço (72,5 por cento), ombros (46,1 por cento), pulsos e mãos (44,1 por cento), coluna torácica (52 por cento) e coluna lombar (51 por cento). A dor atrapalhou as atividades em 53,9 por cento. As enfermeiras reportaram mais regiões corporais afetadas por dor (1,71 versus 0,98, p = 0,036). Houve associação entre dorsalgia e desequilíbrio esforço/recompensa (médicos: OR = 4,91, IC 95 por cento: 1,32-18,22; enfermeiras: OR = 5,58, IC 95 por cento: 1,09-28,45). Conclusões: A prevalência da dor musculoesquelética, especialmente cervical, dorsal e lombar é elevada, similar a outros reportes. As dimensões do modelo ERI se associaram com dor cervical, dor em ombros dorsalgia e dor lombar...

Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses / Fatores de risco físico e psicossocial para distúrbios musculoesqueléticos em enfermeiras brasileiras e italianas

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.

Como parte da pesquisa internacional CUPID, comparamos os fatores de risco físico e psicossocial para distúrbios osteomusculares entre enfermeiras no Brasil e na Itália. Foram coletados dados com questionários sobre distúrbios osteomusculares e seus fatores de risco potenciais com 751 enfermeiros de hospitais públicos. Com modelos de regressão logística específicas para cada país, investigamos a associação entre atividades físicas estressantes e as características psicossociais, com dores em sítios específicos e múltiplos, assim como ausências motivadas por doença. Não encontramos clara relação entre dor lombar e levantamento de pesos, porém dores no pescoço e ombros foram as mais relatadas entre as enfermeiras que realizam trabalho prolongado, com braços elevados. As dores na lombar, pescoço, ombros e em múltiplos sítios foram associadas à tendência somatizante e à ausência por doença em ambos os países. Nossos achados reforçam o papel da tendência somatizante como fator predisponente para distúrbios osteomusculares, atuando como um importante mediador da resposta individual.

Shoulder pain and dysfunction in 150 type 2 diabetes mellitus patients / Dor e disfunção do ombro em 150 pacientes com diabetes melito tipo 2

OBJECTIVE: To study the prevalence of shoulder pain and dysfunction in patients from Southern Brazil with diabetes mellitus (DM) and to evaluate the association of pain and dysfunction with diabetes control and epidemiological factors. SUBJECTS AND METHODS: We studied 150 patients with type 2 DM for pain and shoulder dysfunction with the UCLA-m (modified University of California at Los Angeles Shoulder Rating Scale); for epidemiological and treatment data, values of Hb A1C and plasma glucose were analyzed. RESULTS: Pain was present in 63.4%, and dysfunction in 53.4% of the studied sample; 26.6% of the patients rated shoulder performance as bad. No association was found between Hb A1C or plasma glucose and joint function, except for active flexion of the shoulder and fasting glucose (p = 0.026). Women had worse shoulder performance (p = 0.0043), as did elderly patients (p < 0.0001). CONCLUSIONS: Shoulder pain and dysfunction is highly prevalent in patients with type 2 diabetes; these disorders affect more women and the elderly.

OBJETIVO: Estudar a prevalência de dor e disfunção do ombro em pacientes com diabetes melito (DM) do sul do Brasil e verificar a possível associação com controle glicêmico e fatores epidemiológicos. SUJEITOS E MÉTODOS: Estudaram-se 150 pacientes com DM tipo 2 para dor e disfunção do ombro pelo instrumento UCLAm (University of California at Los Angeles Shoulder Rating Scale modificada), dados epidemiológicos e de tratamento, valores de Hb A1C e glicemia de jejum. RESULTADOS: Verificou-se que havia dor em 63,4% e disfunção em 53,4% da amostra estudada. Em 26,6% dos pacientes, o desempenho do ombro foi considerado ruim. Não se encontrou associação de Hb A1C e glicemia de jejum com dor e disfunção do ombro salvo pela associação entre flexão ativa dessa articulação com glicemia de jejum (p = 0,026). As mulheres tinham pior desempenho do ombro (p = 0,0043), assim como os mais idosos (p < 0,0001). CONCLUSÕES: Existe uma prevalência muito alta de dor e disfunção do ombro em pacientes com DM tipo 2, sendo maior em mulheres e idosos.

Risk factors and prevalence of musculoskeletal disorders among Jordanian dentists

To investigate the prevalence of Musculoskeletal Disorders [MSDs] symptoms [hand/wrist, neck, shoulder and back pain] among dentists and to identify the risk factors associated with these symptoms. A random sample of 200 dentists [114 males [mean age 40.6 years] and 86 females [mean age 40.1 years] were personally interviewed using a structured questionnaire. The questionnaire assessed age, gender, presence of MSDs, daily working hours, years of experience, working position, participants' knowledge of correct working posture and employment of dental surgeon assistant. Data were processed and analyzed by Chi-square test. P value was set at < 0.05. The majority of participants were general practitioners [87.5%]. 86% of the study sample suffered one or more of the MSDs [back pain [56%], neck pain [47%], shoulder pain [39%] and hand/wrist pain [26%]]. Females reported more shoulder pain and less back pain than males [P=0.001]. Neck, shoulder and back pain were significantly increased among older dentists and dentists with more years of professional experience [P<0.0001]. More than half of the participants were not aware of the correct working postures [62.5%], the more the awareness of healthy postures the less the hand/wrist, neck and back pain [P < 0.05]. Hand/wrist pain was most prevalent among dentists who only worked while standing while least prevalent among dentists mixing between sitting and standing postures [P<0.0001]. MSDs are common among Jordanian dentists. There seems to be a substantial need for further training and continuing education on occupational health among Jordanian dentists

Aplicación de farmacopuntura en afecciones dolorosas del hombro / Application pharmacopuncture in painful affections of the shoulder

Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular.

We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve.

Work related complaints among dentists.

The objective of this study was to describe the occurrence of neck pain, shoulder pain and back pain among dentists and to assess the risk factors affecting them. Sixty-eight dentists from Dharan and Biratnagar were interviewed using pretested questionnaires in January 2006. Back pain was the most common complaint affecting almost 80% of the study population, followed by neck pain (58.8%) and shoulder pain (47%). The frequency of shoulder pain among female dentists was nearly double that of males (P=0.009). The mean days of neck pain among males was significantly higher as compared to females (P=0.048). The study suggests that musculoskeletal complaints are common among dentists, though they are not of severe nature. There is a scope for further decreasing the prevalence and severity of these disorders by performing regular specific exercises.

Role of ultrasound in rotator cuff injury

To determine the role of ultrasound [US] in Rotator cuff pathologies and to correlate the accuracy of Ultrasonography [USG] findings in rotator cuff pathologies with b Magnetic Resonance Imaging. It was a Descriptive study. Study was conducted in Department of Radiology, PNS Shifa Karachi, where Grey Scale as well as Color Doppler USG and Fluoroscopy was available. However the facilities of MRI were utilized from other Radiology departments in Karachi; namely, National Medical Centre [NMC], Advanced Radiology Clinic [ARC] and Agha Khan University Hospital [AKUH] on referral basis. The study involved 50 patients of both sexes between 15-60 years of age who presented with shoulder pain and stiffness, in out-patient departments or admitted in surgical/orthopedic wards. They were referred to the Radiology department PNS Shifa for X-Rays and US shoulder. All of them were followed by Magnetic Resonance Imaging. Patients were 32 males and 18 females of more than 15 years of age. Rotator cuff tears were suggested on US by finding thinning or absence of cuff, by hyper or hypo echoic areas in cuff and by criteria of the abnormal cuff-bursa interface. Out of 50 patients 35 patients were diagnosed on US, as having rotator cuff tears while 15 patients were reported normal. 21 out of 35 patients were having full thickness tear while 14 had partial thickness tears. When MRI was conducted in these patients, it showed 39 rotator cuff tears out of 50 patients while 11 patient

ere diagnosed as normal. 26 out of 39 patients were having full thickness tears while 13 had partial thickness tears. Ultrasound had high sensitivity, specificity, positive predictive values and accuracy. We conclude that MRI and US are both sensitive in detection of abnormalities of the rotator cuff. In our set up; Ultrasound is an accurate, non invasive and economic mode of investigation for diagnosing rotator cuff pathologies

A ultra-sonografia na avaliação da síndrome do ombro doloroso: análise de uma série de casos / The ultrasonography in the assessment of painful shoulder syndrome: analysis of cases serie

Com objetivo de estudar os possíveis achados ultra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avaliados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluídos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipô de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador.