Effect of pulsed electromagnetic field therapy in patients with supraspinatus tendon tear

SUMMARY OBJECTIVE: The aim of this study was to compare the effect of transcutaneous electrical nerve stimulation (TENS), ultrasound (US), and pulsed electromagnetic field (PEMF) combination with TENS and US therapy alone in patients with supraspinatus tear. METHODS: Forty patients were included in this study. The patients were randomly divided into two groups as follows: PEMF (n=20) and Sham (n=20) groups. PEMF was applied to the first group at a frequency of 50 Hz, 25 G intensity, and 20 min/session. The device was turned off while PEMF was applied to the second group. Diathermy (US) and electrotherapy (TENS) were applied to both groups for 10 sessions. Numerical Rating Scale (NRS), University of California-Los Angeles (UCLA) Shoulder Scale, and Shoulder Pain and Disability Index (SPADI) were used as outcome measures. RESULTS: In both groups, there was a significant improvement in the NRS, UCLA Shoulder Scale, and SPADI scores after treatment compared with pretreatment (p<0.05). In the comparison of the difference between the pretreatment and posttreatment measurement values between the groups, no significant difference was found between PEMF and Sham groups according to the NRS (p=0.165), UCLA Shoulder Scale (p=0.141), and SPADI (p=0.839) scores. CONCLUSIONS: In our study, a combination of PEMF therapy with conventional physical therapy modalities was not found to be superior to the conventional therapy alone, and adding it to the routine treatment of symptomatic supraspinatus tear would not provide any additional benefit.

Efficacy of ultrasound guided suprascapular block in patients with chronic shoulder pain: observational, retrospective study / Eficácia do bloqueio do nervo supraescapular guiado por ultrassom em pacientes com dor crônica no ombro: estudo observacional retrospectivo

Abstract Introduction: Painful shoulder syndrome is a frequent condition among the elderly and an important cause of functional disability. As the conservative treatment is not always effective, ultrasound guided suprascapular nerve blockade presents as an important alternative treatment. Objective: To evaluate the efficacy and safety of the use of 0.25% levobupivacaine and 40 mg of triamcinolone in the suprascapular nerve blockade in patients with chronic pain in the shoulder. Methods: A retrospective, descriptive and analytical study of 71 patients submitted to suprascapular nerve infiltration between August 2014 and March 2017. Surveys were carried out to patients before the technique was performed, after 72 hours and at 1, 3 and 6 months. Pain intensity was assessed using a numeric pain scale (NPS). Results: Out of the 71 patients who underwent a blockade of the suprascapular nerve, 81.2% reported a decrease in pain at 72 hours. In the first, third and sixth month, respectively, 89.8%, 76.1% and 61.8% of the patients presented pain relief. A statistically significant difference (p < 0.001) was verified between NPS and the 4 moments assessed after the technique. 43.7% had total pain remission (NPS = 0) at six months. Global effectiveness of suprascapular nerve blockade was 60.6% and for the subgroup of patients with rotators' cuff patology was 62.2%. No complications were reported regarding the suprascapular nerve block. Conclusion: The results show that ultrasound-guided blockade of the suprascapular nerve using 0.25% levobupivacaine and 40 mg of triamcinolone is a safe and effective treatment in patients with chronic shoulder pain.

Resumo Introdução: A síndrome do ombro doloroso é uma condição frequente entre os idosos e uma causa importante de incapacidade funcional na população em geral. O tratamento conservador nem sempre é eficaz, pelo que o bloqueio do nervo supraescapular guiado por ecografia apresenta-se como uma opção de tratamento válida. Objetivo: Avaliação da eficácia e segurança do uso de levobupivacaína a 0,25% e 40 mg de triancinolona no bloqueio do nervo supraescapular ecoguiado em doentes com dor crônica no ombro. Métodos: Realizou-se um estudo retrospectivo observacional, descritivo e analítico com 71 doentes submetidos à infiltração do nervo supraescapular entre agosto de 2014 e março de 2017. Foram aplicados questionários antes da realização da técnica, após 72 horas; 1, 2 e 6 meses. A intensidade da dor foi avaliada usando a Escala de Avaliação Numérica (EAN). Resultados: Dos 71 doentes submetidos ao bloqueio do nervo supraescapular; 81,2% referiram diminuição da dor às 72 horas. Aos primeiro, terceiro e sexto mês, respectivamente 89,8%; 76,1% e 61,8% apresentaram melhoria da dor. Verificou-se uma diferença estatisticamente significativa (p < 0,001), entre a EAN inicial e os 4 momentos após a realização da técnica. 43,7% dos doentes tiveram remissão total da dor (EAN = 0) aos seis meses. A eficácia global do bloqueio do nervo supraescapular foi de 60,6% e, para o subgrupo com patologia da coifa dos rotadores, de 62,2%. Nenhuma complicação do bloqueio do NSE foi registrada. Conclusão: Este estudo mostra que o bloqueio eco-guiado do NSE usando levobupivacaína a 0,25% e 40 mg de triancinolona é um procedimento seguro e eficaz em doentes com dor crônica no ombro.

What do Cochrane Systematic Reviews say about conservative and surgical therapeutic interventions for treating rotator cuff disease? Synthesis of evidence

ABSTRACT BACKGROUND: Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE: The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING: Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS: This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS: Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS: The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation. Protocol registration number in the PROSPERO database: ID - CRD42018096578.

Queixas musculoesqueléticas no ombro: características dos usuários e dos atendimentos na atenção primária / Quejas musculoesqueléticas en el hombro: características de los pacientes en las consultas de la atención primaria / Musculoskeletal shoulder complaints: characteristics of patients and consultations in primary care

RESUMO A dor no ombro representa a terceira principal queixa musculoesquelética da população. Afeta fatores físicos, psicológicos e econômicos do indivíduo. A atenção primária à saúde é essencial para a eficácia do cuidado dos pacientes acometidos. Este estudo é observacional transversal e obteve um perfil dos usuários e das consultas médicas com relato de dor no ombro durante um ano na atenção primária do município de Ribeirão Preto (SP). Foram analisados em prontuários os registros das consultas médicas agendadas e sem agendamento prévio. Nestes registros foram coletados dados dos pacientes que apresentaram queixas de dor musculoesquelética no ombro (dados sociodemográficos e características das consultas), que foram analisados de forma descritiva e pelos testes qui-quadrado de Pearson, razão de chance e regressão logística múltipla. A frequência de consultas médicas por queixa de dor no ombro foi de 9,2%. O perfil dos indivíduos que se queixaram de dor no ombro se caracterizava por mulheres, com idade avançada, casadas, alfabetizadas e que apresentavam alguma ocupação. As consultas em sua maioria tiveram retornos agendados, oferecimento de orientações terapêuticas e poucos encaminhamentos.

RESUMEN El dolor en el hombro representa la tercera principal queja musculoesquelética de la población. Acomete los factores físicos, psicológicos y económicos del individuo. La atención primaria a la salud es esencial para la eficacia del cuidado de los pacientes afectados. Este estudio de tipo observacional transversal obtuvo un perfil de los usuarios y de las consultas médicas en que había relato de dolor en el hombro durante un año en la atención primaria del municipio de Ribeirão Preto (SP). Se analizaron los registros de las consultas médicas programadas y sin programación previa. En estos registros se recolectaron los datos de los pacientes que se quejaban de dolor musculoesquelético en el hombro (sus datos sociodemográficos y las características de las consultas), los cuales fueron analizados de forma descriptiva y por la prueba chi-cuadrado de Pearson, por las razones de prevalencia y por la regresión logística múltiple. La frecuencia de consultas médicas por queja de dolor en el hombro fue del 9,2%. El perfil de los individuos que se quejaron de dolor en el hombro fue de mujeres, con edad avanzada, casadas, alfabetizadas y que se dedicaban a alguna actividad. Las consultas en su mayoría tuvieron retornos programados, ofrecimiento de orientaciones terapéuticas y pocos encaminamientos.

ABSTRACT Shoulder pain is the third most common musculoskeletal complaint of the world population. It affects the physical, psychological and financial situation of the individual. Primary care is essential to an effective health care for affected patients. This cross-sectional and observational study has the purpose of characterizing the profile of users of the primary health care service, and analyzing the medical records with shoulder pain reports over an one-year period in the primary care service of Ribeirão Preto - SP. Medical records of patients with scheduled and unscheduled medical consultations were analyzed. Data from patients with musculoskeletal shoulder pain - sociodemographic data and the consultation characteristics - were collected and analyzed descriptively and by Pearson's Chi-squared test, Odds Ratio and Multiple Logistic Regression. The frequency of shoulder pain in the primary care was 9.2%. The profile of individuals who complained about shoulder pain was advanced age, married, literate and working women. Most consultations had scheduled follow-up consultations, therapeutic guidance and few referrals.

Patient-reported measures of quality of life and functional capacity in adhesive capsulitis / Medidas relatadas pelos pacientes sobre qualidade de vida e capacidade funcional em capsulite adesiva

Summary Objective: To evaluate patient-reported measures of quality of life and functional capacity in adhesive capsulitis before and after suprascapular nerve block treatment; to analyze the influence of clinical and sociodemographic variables on both the outcome and correlation between the respective instruments. Method: A prospective clinical study was performed with adhesive capsulitis patients. Inclusion criteria were clinical diagnosis of adhesive capsulitis and a shoulder imaging test. The WHOQOL-BREF and DASH instruments were administered before and after treatment. A Constant test score of 55 points was used as a cutoff point for discontinuation of treatment. Mean values were compared using paired t-test and Wilcoxon. The Pearson or Spearman coefficients were used for correlation analysis. Multiple linear regression analysis was carried out using variables with p<0.20 as predictors in univariate analysis and WHOQOL domains and DASH as outcomes. The significance level was 5%. Results: Forty-three patients were evaluated. The comparison between WHOQOL-BREF and DASH mean values before and after the blocks, p<0.05. DASH correlated negatively with the physical, psychological and environmental WHOQOL-BREF domains. Older patients and those with higher levels of education influenced the improvement in patients' quality of life and functional capacity. Conclusion: The improvement of adhesive capsulitis with treatment involves an improvement in quality of life and functional capacity. The greater functional capacity of the shoulder matches a better quality of life for patients. Age and education level are the variables that most influence improvement in quality of life and functional capacity.

Resumo Objetivo: Avaliar as medidas relatadas pelos pacientes sobre qualidade de vida e capacidade funcional em capsulite adesiva antes e após tratamento com bloqueios do nervo supraescapular; analisar a influência das variáveis clínicas e sociodemográficas em ambos os desfechos e a correlação entre os respectivos instrumentos. Método: Estudo clínico prospectivo foi realizado em pacientes com capsulite adesiva. Os critérios de inclusão foram diagnóstico clínico de capsulite adesiva e realização de exames de imagem do ombro. Os instrumentos WHOQOL-BREF e DASH foram aplicados antes e após o tratamento. Utilizou-se o escore de Constant com ponto de corte em 55 para a interrupção do tratamento. As médias dos valores foram comparadas pelos testes t-pareado e Wilcoxon. Na análise de correlação foi utilizado o coeficiente de Pearson ou de Spearman. Foi realizada análise de regressão linear múltipla utilizando como preditoras as variáveis com p<0,20 na análise univariada e como desfechos os domínios do WHOQOL e o DASH. O nível de significância foi de 5%. Resultados: Foram avaliados 43 pacientes. A comparação entre as médias dos valores do WHOQOL-BREF e DASH antes e após os bloqueios apresentou um p<0,05. Houve correlação negativa entre o DASH e os domínios físico, psicológico e ambiental do WHOQOL-BREF. Os pacientes mais velhos e com maior grau de escolaridade influenciaram a melhora da qualidade de vida e capacidade funcional dos pacientes. Conclusão: A melhora da capsulite adesiva com o tratamento implica melhora da qualidade de vida e capacidade funcional. Quanto maior a capacidade funcional do ombro, melhor a qualidade de vida dos pacientes. A faixa etária e o grau de escolaridade são as variáveis que mais influenciam a melhora da qualidade de vida e capacidade funcional.

Resultados de la electrólisis percutánea intratisular en el dolor en el hombro: infraespinoso, un ensayo controlado aleatorio / Résultats de l'Électrolyse Percutanée Intra-tissulaire contre la douleur de l'épaule: Muscle sous-épineux. Une étude contrôlée et randomisée / Results of the Electrolysis Percutaneous Intratissue in the shoulder pain: infraspinatus, A Randomized Controlled Trial

Background: The Electrolysis Percutaneous Intratissue (EPI®) is a novel technique that provokes a local inflammatory process, allowing the phagocytises and affected tissue to repair. Objectives: The work is aimed to: a) verify the effectiveness of the EPI® when there is shoulder pain, b) locate where the EPI® should be applied, c) and find the possible interaction between the trigger points and the tendon pain. Design: Randomized controlled trial. Setting: Institute of Physiotherapy and Sports. Method: A double randomized experimental longitudinal study was conducted on four groups of 10 people aged 34-47 years with pain in the shoulder. In the first study there were three intervention groups and a control group. In the second study, the group with the best results in the first study served as a control group. Measurements: The variables measured were the perceived pain and the restriction for abduction, internal and external rotation. Results: Although the three intervention groups improved respect to the control group when the EPI® was applied, the results show that the EPI® is more effective when it is applied in all detected trigger points and to tendon pain. Conclusions: The EPI® is more effective if applied in the infraspinatus muscle and the tendon than applied only to one of the two structures, when both structures have pain. Limitations: The study could have tested the involvement of different structures and its related biomechanical implications. It could have also considered more variables(AU)

Introducción: la electrólisis percutánea intratisular (EPI®) es una novedosa técnica que provoca un proceso inflamatorio local, que permite la fagocitosis y la reparación del tejido afectado. Objetivos: verificar la efectividad de la EPI® cuando hay dolor del hombro, b) localizar dónde debería ser aplicada la EPI® y C) y determinar la interacción entre los posibles puntos de activación y el dolor del tendón. Diseño: estudio controlado aleatorio. Ubicación: Instituto de Fisioterapia y el Deporte. Método: se realizó un estudio longitudinal experimental aleatorizado doble en cuatro grupos de 10 personas con edades entre 34-47 años que sufrían dolor en el hombro. En el primer estudio hubo tres grupos de intervención y un grupo de control. En el segundo estudio, el grupo que tuvo mejores resultados en el primer estudio sirvió como grupo de control. Mediciones: las variables que se midieron fueron dolor percibido y la restricción de la abducción, rotación interna y rotación externa. Resultados: aunque los tres grupos de intervención mejoraron respecto al grupo de control cuando se aplicó la EPI®, los resultados muestran que la EPI® es más eficaz cuando se aplica en todos los puntos de activación detectados y donde hay dolor en los tendones. Conclusiones: la EPI® es más eficaz si se aplica en el músculo infraespinoso y el tendón que si se aplica solo a una de las dos estructuras, cuando ambas presentan dolor. Limitaciones: el estudio podría haber probado la participación de diferentes estructuras y sus implicaciones biomecánicas relacionadas. Podría también haber tenido en cuenta más variables(AU)

Introduction: L'Électrolyse Percutanée Intra-tissulaire (EPI®) est une nouvelle technique qui produit une réaction inflammatoire locale permettant la régénération tissulaire du tendon, ligament, muscle, etc. Objectifs: Le but de ce travail est de, a) confirmer l'effectivité de l'EPI® lorsqu'il y a une douleur au niveau de l'épaule, b) localiser la région sur laquelle l'EPI® doit être appliqué, et c) trouver la possible interaction entre les points de stimulation et la douleur tendineuse. Dessin: Une étude contrôlée et randomisée. Lieu: Institut de physiothérapie et de sports. Méthode: Une étude randomisée, expérimentale et longitudinale de quatre groupes de 10 personnes, âgées de 34 - 47 ans et atteintes d'une douleur au niveau de l'épaule, a été réalisée. Dans la première étude, il y a eu trois groupes expérimentaux et un groupe témoin. Dans la deuxième étude, le groupe ayant les meilleurs résultats dans la première étude a servi de groupe témoin. Évaluations: Parmi les variables analysées, on peut trouver la perception de la douleur et la limitation de l'adduction et de la rotation interne et externe. Résultats: Quoique les trois groupes expérimentaux ont éprouvé une amélioration vis-à-vis le groupe témoin après l'application de l'EPI®, les résultats ont montré que cette technique est plus effective si elle est appliquée sur tous les points de stimulation détectés et contre la douleur tendineuse. Conclusions: L'EPI® est plus effective si elle est appliquée sur le muscle sous-épineux et les tendons que sur une seule de ces deux structures, quand toutes les deux sont douloureuses. Limitations: L'étude pouvait avoir examiné les différentes structures compromises et leurs implications biomécaniques associées. Elle pouvait avoir aussi considéré beaucoup plus de variables(AU)

Avaliação da acupressão auricular na síndrome do ombro doloroso: estudo de caso / Evaluation of ear acupressure on painful shoulder syndrome: case study / Evaluación de la acupresión auricular sobre el síndrome de hombro doloroso: estudio de caso

A Síndrome do Ombro Doloroso (SOD) é definida como dor e limitação funcional decorrente do acometimento de estruturas estáticas e dinâmicas do ombro, como ligamentos, cápsula e músculos. É uma das queixas mais comuns e incapacitantes do sistema musculoesquelético na população em geral com uma prevalência estimada entre 15 a 25%. Este estudo objetivou avaliar os resultados da acupressão auricular quando usada como terapia no tratamento da Dor crônica, secundária à SOD, quanto ao efeito analgésico e terapêutico satisfatório e o tempo estimado de tratamento. Para a obtenção do objetivo foi realizado um Estudo de Caso que teve como intervenção a acupressão auricular com esferas de cristais e como indicador de resultado o questionário Penn Shoulder Score (PSS - Brasil). Os dados foram analisados qualitativa e quantitativamente. Conclui-se que a auriculoterapia é uma importante técnica terapêutica, pois o estudo demonstrou uma melhora na pontuação total do PSS - Brasil em 34,3%.

The Painful Shoulder Syndrome (PSS) is defined as pain and functional limitation resulting from impairment of static and dynamic structures of the shoulder, such as ligaments, capsule and muscles. It is one of the most common and disabling of the musculoskeletal system in the general population with prevalence estimated between 15-25%. This study aimed to evaluate the results of auricular acupressure when used as therapy in the treatment of chronic pain secondary to SOD, and the analgesic effect and therapeutic satisfactory and the estimated time of treatment. To obtain the objective was to perform a case study was to intervene with auricular acupressure beads and crystals as an indicator of the outcome questionnaire Penn Shoulder Score (PSS - Brazil). Data were analyzed qualitatively and quantitatively. We conclude that auriculotherapy is an important therapeutic technique, because the study showed an improvement in the total score of the PSS - Brazil at 34.3%.

El síndrome de hombro doloroso (SHD) se define como dolor y limitación funcional que resulta del deterioro de las estructuras estáticas y dinámicas de los hombros, como ligamentos, cápsula y los músculos. Es uno de los más comunes y incapacitantes del sistema músculo-esquelético en la población general con una prevalencia estimada entre el 15-25%. Este estudio tuvo como objetivo evaluar los resultados de la digito presión auricular cuando se usa como terapia en el tratamiento del dolor crónico secundario a la SHD, y el efecto analgésico y terapéutico satisfactorio y el tiempo estimado de tratamiento. Para lograr el objetivo ha sido realizar un estudio de caso Estudo de Caso en que se tuve como intervención la acupressão auricular con esferas de cristales y como indicador de resultado el cuestionario Penn Shoulder Score (PSS - Brasil). Los datos se analizaron cualitativa y cuantitativamente. Llegó-se a la conclusión de que la auriculoterapia es una técnica terapéutica importante, porque el estudio demostró una mejoría en la puntuación total de la PSS - Brasil en el 34,3%.

Assessment of the results from arthroscopic surgical treatment of adhesive capsulitis / Avaliacao dos resultados do tratamento cirurgico artroscopico da capsulite adesiva

OBJECTIVE: Describe the outcomes of patients with adhesive capsulitis treated with arthroscopic surgical procedure. METHODS: Between January and September of 2009, 9 patients (10 cases) underwent arthroscopic surgical release. There were 4 male (one bilateral) and 5 female patients. Their mean age was 51 years (27-63). The time from onset of symptoms to the surgical procedure averaged 23.4 months (6-38). Preoperative assessment was based on the UCLA and Constant score. ROM was evaluated with one week and six months of surgery. RESULTS: According to UCLA shoulder score (p < 0.01) it increased from 9.8 preoperatively (6-14) to 31.6 postoperatively (26-35) and the Constant (p < 0.01) from 20 (13-27) to 79.2 (66-91). ROM improved significantly, with mean passive elevation changing from 89° (80-100°) preoperatively to 150° postoperatively with one week and 153° with six months, mean passive external rotation changing from 12.5° (0-30°) preoperatively to 46° (one week) and 56° (six months) postoperatively, and passive internal rotation from L5 (T12-gluteus) to T11 (one week) and T9 (six months). There was not statistical significance of the duration of the disease and the postoperative result. CONCLUSION: This study shows that the surgical treatment of adhesive capsulitis with arthroscopic capsular release and manipulation appears to be a safe procedure that results in pain relief and functional gain.

OBJETIVO: Descrever os resultados dos pacientes com capsulite adesiva submetidos ao tratamento cirúrgico artroscópico. MÉTODOS : Estudo prospectivo com nove pacientes (10 casos) de capsulite adesiva submetidos ao tratamento cirúrgico entre janeiro e setembro de 2009. Cinco pacientes eram do sexo feminino e quatro do masculino (um bilateral), com faixa etária média de 51 anos (27-63). O tempo médio entre o início dos sintomas e a cirurgia foi 23,4 meses (6-38). Foram usados os escores da UCLA e Constant para avaliar os resultados e o ganho do arco de movimento com uma semana e seis meses. RESULTADOS : Houve aumento no escore da UCLA (p < 0,01) de 9,8 no pré-operatório (6-14) para 31,6 no pós-operatório (26-35) e no de Constant (p < 0,01) de 20 (13-27) para 79,2 (66-91). As médias da mobilidade articular passiva no período pré-operatório foram de 89º de flexão anterior (80º-100º), 12,5º de rotação lateral (0º-30º) e L5 de rotação medial (T12-Glúteo), com aumento médio significante estatisticamente na primeira semana para 150º/46º/T11 e para 153º/56º/T9 com seis meses. Não existiu significância estatística com relação ao tempo de evolução da doença e o resultado pós-operatório. CONCLUSÃO : Este estudo demonstrou que o tratamento cirúrgico para capsulite adesiva com liberação capsular artroscópica associada à manipulação é um procedimento seguro e que resulta em alívio da dor e recuperação do arco de movimento.

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II / Suprascapular nerve block: important procedure in clinical practice. Part II

O bloqueio do nervo supraescapular é um método de tratamento reprodutível, confiável e extremamente efetivo no controle da dor no ombro. Esse método tem sido amplamente utilizado por profissionais na prática clínica, como reumatologistas, ortopedistas, neurologistas e especialistas em dor, na terapêutica de enfermidades crônicas, como lesão irreparável do manguito rotador, artrite reumatoide, sequelas de AVC e capsulite adesiva, o que justifica a presente revisão (Parte II). O objetivo deste estudo foi descrever as técnicas do procedimento e suas complicações descritas na literatura, já que a primeira parte reportou as indicações clínicas, drogas e volumes utilizados em aplicação única ou múltipla. Apresentamse, detalhadamente, os acessos para a realização do procedimento tanto direto como indireto, anterior e posterior, lateral e medial, e superior e inferior. Diversas são as opções para se realizar o bloqueio do nervo supraescapular. Apesar de raras, as complicações podem ocorrer. Quando bem indicado, este método deve ser considerado.

The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifies the present review (Part II). The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the first part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

Bloqueio do nervo supraescapular: procedimento importante na prática clínica / Suprascapular nerve block: important procedure in clinical practice

JUSTIFICATIVA E OBJETIVOS: A dor no ombro é uma queixa frequente que ocasiona grande incapacidade funcional no membro acometido, assim como redução na qualidade de vida dos pacientes. O bloqueio do nervo supraescapular é um método terapêutico eficaz e vem sendo cada vez mais utilizado pelos anestesiologistas tanto para anestesia regional quanto para analgesia pós-operatória de cirurgias realizadas nesta articulação, o que justifica a presente revisão, cujo objetivo principal é descrever a técnica aplicada e as indicações clínicas. CONTEÚDO: Apresenta-se a anatomia do nervo supraescapular, desde a sua origem do plexo braquial até os seus ramos terminais, assim como as características gerais e a técnica empregada na execução do bloqueio deste nervo, as principais drogas utilizadas e o volume e as situações em que se faz jus a sua aplicação. CONCLUSÕES: O bloqueio do nervo supraescapular é um procedimento seguro e extremamente eficaz na terapia da dor no ombro. Também de fácil reprodutibilidade, está sendo muito utilizado por profissionais de várias especialidades médicas. Quando bem indicado, este método deve ser considerado.

BACKGROUND AND OBJECTIVES: Shoulder pain is a frequent complaint that results in great functional disability in the affected shoulder as well as the decrease in patients' quality of life. Suprascapular nerve block is an effective therapeutic method and has been increasingly used by anesthesiologists both for regional anesthesia and postoperative analgesia of surgeries carried out in this articulation, which justifies this review, whose main purpose was to describe the applied technique and clinical indications. CONTENT: It is presented the anatomy of suprascapular nerve, since its brachial plexus origin until its terminal branches, as well as general characteristics and technique employed to carry out the block of this nerve, main drugs used, volume and situations that give rise to its applications. CONCLUSIONS: Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration.

JUSTIFICATIVA Y OBJETIVOS: El dolor en el hombro es un quejido frecuente que ocasiona una gran incapacidad funcional en el miembro perjudicado, como también la reducción en la calidad de vida de los pacientes. El bloqueo del nervio supraescapular es un método terapéutico eficaz y ha venido siendo cada vez más utilizado por los anestesiólogos tanto para la anestesia regional como para la analgesia postoperatoria de cirugías realizadas en esa articulación, lo que justifica la presente revisión cuyo objetivo principal es describir la técnica aplicada y las indicaciones clínicas. CONTENIDO: Presentamos la anatomía del nervio supraescapular, desde su origen, y desde el plexo braquial hasta sus ramas terminales, como también las características generales y la técnica usada en la ejecución del bloqueo de ese nervio, los principales fármacos utilizados y el volumen y las situaciones en que se justifica su aplicación. CONCLUSIONES: El bloqueo del nervio supraescapular es un procedimiento seguro y extremadamente eficaz en la terapia del dolor en el hombro. También es fácilmente reproducible y está siendo muy utilizado por profesionales de varias especialidades médicas. Cuando está bien indicado, el método debe ser tenido en cuenta.

Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series / Treino excêntrico para abdutores do ombro melhora dor, função e desempenho isocinético em sujeitos com síndrome do impacto: série de casos

BACKGROUND: Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. OBJECTIVES: To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. METHODS: Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. RESULTS: DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. CONCLUSIONS: This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

CONTEXTUALIZAÇÃO: Tratamentos conservadores têm sido propostos para pessoas com síndrome do impacto (SI) do ombro, como fortalecimento do manguito rotador e dos músculos escapulares e alongamento dos tecidos moles do ombro. No entanto, são escassos os estudos que analisaram a eficácia do treinamento excêntrico no tratamento da SI. OBJETIVOS: Avaliar os efeitos do treinamento excêntrico para abdutores do ombro na dor, função e desempenho isocinético durante a abdução concêntrica e excêntrica do ombro em indivíduos com SI. MÉTODOS: Vinte indivíduos (sete mulheres, 34,2 DP 10,2 anos, 1,7 DP 0,1 m, 78,0 DP 16,3 kg) com SI unilateral completaram o protocolo do estudo. Realizou-se treinamento isocinético excêntrico bilateral a 60º/s para abdutores do ombro durante seis semanas consecutivas, duas vezes por semana, em dias alternados. Para cada dia de treinamento, foram realizadas três séries de dez repetições, com um período de descanso de 3 minutos entre as séries para cada lado. A amplitude de movimento treinada foi de 60° (de 80° a 20°). O questionário Disabilities of the Arm, Shoulder and Hand (DASH) foi utilizado para avaliar a função e os sintomas dos membros superiores. O pico de torque, o trabalho total e o tempo de aceleração foram avaliados durante a abdução concêntrica e excêntrica do braço a 60º/s e 180º/s por meio de um dinamômetro isocinético. RESULTADOS: As pontuações do DASH, o pico de torque, o trabalho total e o tempo de aceleração melhoraram (p<0,05) após o período de intervenção. CONCLUSÕES: Este estudo sugere que o treinamento isocinético excêntrico para abdutores do ombro melhora a função física dos membros superiores em indivíduos com SI.

Suprascapular nerve block in the treatment of frozen shoulder

To determine the effectiveness of suprascapular nerve block in the treatment of frozen shoulder. Quasi experimental study. Department of Orthopedic Surgery Hayatabad Medical Complex Peshawar, from March 2010 to December 2010. Patients with frozen shoulder received a single suprascapular nerve block. Shoulder pain and disability index [SPADI] were used as main outcome measure of pain and disability. To determine the effectiveness of suprascapular nerve block in the treatment of frozen shoulder. There were total of 64 patients in this study. The mean age was 65.3 +/- 10.1 year. Using SPADI, the mean baseline total, subscale pain and disability scores were 70.9 +/- 6.8, 72.3 +/- 6.9 and 69.5 +/- 8.5 respectively which improved to 24.6 +/- 5.6, 22.3 +/- 5.3 and 27.5 +/- 6.6 respectively at 4 week of suprascapular nerve block of the affected shoulder with p value of 0.000 each. Suprascapular nerve block is safe and effective treatment for relieving pain and decreasing disability in frozen shoulder

[Effect of slow stroke back massage [SSBM] on shoulder pain and hand function in patients with stroke]

Shoulder pain is a consequence of hemiplegia among patients with stroke. It makes patient to be dependent to others in their daily living activities. This study aimed to determine the effect of the slow stroke back massage [SSBM] on shoulder pain and hand function among patients with stroke. In this semi-experimental study, 34 patients were recruited among from 70 patients who reffered to rehabilitation center in 2010, according to the inclusion criteria. Participants were randomly allocated into two groups of control and experiment. In the intervention group, the SSBM was implemented for 10 minutes through seven consecutive sessions. Shoulder pain and hand function were measured using the visual pain scale [Visual Analog Scale], and the researcher-made "affected hand function in ADL" instrument, respectively. The measurement was done before and 24 hours after the last session of the intervention. Data were analyzed using descriptive and inferential statistical tests [independent t-test and paired t-test]. At baseline, the mean scores of shoulder pain were 8.4 in both experimental and control groups [P=0.999]. After the intervention, the mean scores of shoulder pain were 1.13 and 8.40 in experimental and control groups, respectively [P<0.001]. At baseline, the mean scores of hand function were 7.46 and 8.93 in the experimental and control groups, respectively [P=0.752]. After the intervention, the mean scores of hand function reached 9.13 and 8.6 in the experimental and control groups, respectively [P=0.918]. According to the results of the study, applying the SSBM as a treatment procedure and care plan by health care providers can be considered as an effective intervention to prevent or reduce shoulder pain and consequently to improve motor function of affected hand in patients with hemiplegia after stroke

Comparison of the efficacy of local corticosteroid injection and physical therapy on pain severity, joint range of motion and muscle strength in patients with shoulder impingement syndrome referred to Rasool-e-Akram Medical Center from April 2008 to September 2009

Subacromial impingement is a common cause of shoulder pain and many patients with this condition recover with conservative management. The most commonly used modalities of non-operative treatment include activity modification, anti-inflammatory medication and subacromial injection of steroid and ultrasound and physical therapy programs. This study assessed the value of physiotherapy versus subacromial corticosteroid injection in patients with shoulder impingement syndrome [SIS]. Seventy three patients with SIS enrolled in the study and treated through physiotherapy [n=37] and subacromial corticosteroid injection [n=36]. Two follow-up sessions accomplished at the end of 4[th] week and 3[rd] month of treatment respectively. Corticosteroid injection caused dramatic improvement in the painful state [p<0.0001] and sleep dysfunction score [p=0.039] in the first follow-up. However, physiotherapy showed significantly better results regarding patients' pain score [p=0.016] and their shoulder join range of motions [p=0.017 and p=0.029 for the abduction and extension, respectively] in their second follow-up. Our study results showed that subacromial corticosteroid injection primarily resulted in more improvement in the impingement symptoms. However, with the long-term follow-up the results were better for the physiotherapy. These results suggest that patients should not undergo surgery before having conservative treatment

Efeito da estimulação elétrica nervosa transcutânea no tratamento da dor no ombro de pacientes com doença renal crônica: relato de caso / Effect of transcutaneous electrical nerve stimulation in the treatment of pain in the shoulder of patients with chronic kidney disease: a two-case report

A doença renal crônica (DRC) pode causar muitas complicações clínicas associadas ao tempo de diálise. A amiloidose é uma dessas complicações e pode levar à dor no ombro, comum em pacientes com DRC. Até o momento, na literatura, só existem relatos de tratamentos cirúrgicos e medicamentosos para este tipo de dor. O objetivo foi descrever os benefícios da estimulação elétrica nervosa transcutânea (TENS) no tratamento da dor no ombro devido à amiloidose em pacientes com DRC. Duas pacientes foram avaliadas 4 vezes num período de 3 meses. Na 1ª avaliação as pacientes foram orientadas e receberam um aparelho de TENS para uso domiciliar (10Hz, 150 µs, 2xdia, 40 min.). A dor foi avaliada utilizando-se a Escala Visual Analógica e o Questionário de Dor de Wisconsin. Os resultados mostram que o tratamento com TENS reduziu a dor no ombro em ambas as pacientes. O tratamento com a TENS pode trazer benefícios para redução da dor no ombro de pacientes com DRC...

The chronic kidney disease (CKD) can cause many clinical complications associated with long-term dialysis. Amyloidosis is one of these complications and it can lead to shoulder pain and actually there are only reports of surgical and medical therapies treating such pain. Objective: To describe the benefits of the transcutaneous electrical nerve stimulation (TENS) in the treatment of pain in the shoulder due to amyloidosis in patients with CKD. Two patients were evaluated 4 times in a 3 months period. In the 1st evaluation, patients were guided on how to use TENS and received a device for domiciliary use (10Hz, 150 µs, 2xday, 40 min.). Pain was evaluated using Visual Analogue Scale and the Wisconsin Brief Pain Questionnaire. The results show that TENS reduced the pain shoulder in both patients. Conclusion: Treatment with TENS can bring benefits for reduction of pain in shoulder of patients with CKD.

Eficacia de la peloidoterapia y cinesioterapia en la capsulitis adhesiva primaria del hombro / Effectiveness of the peloidotherapy and cinesiotherapy in the primary adhesive capsulitis of the shoulder

Se realizó un ensayo clinicoterapéutico controlado para evaluar la eficacia de la peloidoterapia y cinesioterapia en 64 pacientes con capsulitis adhesiva primaria del hombro, atendidos en el Departamento de Fisioterapia y Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba desde enero del 2006 hasta igual mes del 2007. Se conformaron 2 grupos (de estudio y control) de 32 integrantes en cada caso: los primeros recibieron peloidoterapia y cinesioterapia; los segundos: electroterapia y cinesioterapia. A las 10 sesiones terapéuticas había mejorado un mayor número de pacientes del grupo de estudio, mientras que los del grupo control necesitaron más de 20 sesiones para lograrlo. A los 3 meses continuaba la mejoría en 90,6 por ciento de los pacientes del primer grupo, por lo cual se planteó que la combinación de peloidoterapia y cinesioterapia fue más eficaz para eliminar las manifestaciones clínicas de esa inflamación, validada por un nivel de significación de 0,03.

A controlled clinical therapeutical trial was carried out to evaluate the effectiveness of the peloidotherapy and kinesiotherapy in 64 patients with primary adhesive capsulitis of the shoulder, assisted in the Department of Physiotherapy and Rehabilitation of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from January, 2006 to January, 2007. Two groups were conformed (study and control groups) of 32 members in each: the first group received peloidotherapy and kinesiotherapy; the second group: electrotherapy and kinesiotherapy. At the 10 therapeutic sessions a great number of patients of the study group had improved, while those of the control group needed more than 20 sessions to achieve this. At the 3 months the improvement continued in 90,6 percent of the first group patients, reason why it was stated that the peloidotherapy and kinesiotherapy combination was more effective to eliminate the clinical manifestations of that inflammation, validated by a significance level of 0,03.

Outcome measures and psychomotor skills related to shoulder conditions for clinical orthopedic training

This study was designed to assess the ability of physical therapy [PT] students to utilize selected outcome measures such as range of motion [ROM], pain and a number of psychomotor skills and to determine the efficacy of treatment they carried out during orthopedic clinical training. The clinical education booklets in orthopedics of all PT students over a 6-year period were reviewed. Students' application of psychomotor skills such as peripheral joint mobilizations [PJM], proprioceptive neuromuscular facilitation [PNF] techniques, therapeutic exercise techniques as well as utilization of basic outcome measures such as ROM and pain were analyzed with descriptive statistics and paired t test. A majority of students used PJM techniques [78.6%] and PNF techniques [58.6%]. The paired t test indicated that treatment interventions used by the students were associated with improved shoulder joint ROM and decreased pain levels [p < 0.001]. At the same time, therapeutic exercises were employed by the students after PJM and PNF. The most common 'comparable joint sign' was limitation in shoulder abduction ROM, which occurred in 44% of patients seen by the students. PT students' application of PJM, PNF, and therapeutic exercise improved ROM and decreased pain in patients with shoulder pathologies

Toxina botulínica A e intervenção fisioterapêutica no tratamento do ombro doloroso pós acidente vascular cerebral: relato de caso / Botulinum toxin A and physiotherapy intervention in the treatment of the painful shoulder after stroke: case report

A síndrome do ombro doloroso é considerada um achado comum em pacientes que sofreram acidente vascular cerebral. Várias modalidades terapêuticas são apontadas para melhoria do quadro clínico dos pacientes. Neste relato, será apresentado um caso de síndrome do ombro doloroso, cujo tratamento consistiu no emprego de toxina botulínica A associada à fisioterapia. Após quatro meses de tratamento, houve melhorias significativas quanto à dor, espasticidade, amplitude de movimento e qualidade de vida, e isso sugere ser essa associação terapêutica uma ferramenta eficaz contra os efeitos incapacitantes relacionados a esta síndrome.

The syndrome of the painful shoulder is considered a common finding in patients who suffered stroke. Several therapeutic modalities are suggested for the improvement of the patients’ clinical condition. In this report, a case of syndrome of the painful shoulder will be discussed, whose treatment consisted of the use of botulinum toxin A associated to physiotherapy. After a four-month treatment, significant improvements occurred concerning pain, spasticity, range of motion and quality of life, suggesting that this therapeutic association is an efficient tool against the incapacitating effects related to this syndrome.

Effect of therapeutic ultrasound on calcific supraspinatus tendinitis.

Calcific tendinitis is an important cause of shoulder pain. There are various modalities used to treat calcific tendinitis. Ultra-Sound therapy (UST) is a non-invasive modality of treatment. It is not costly. The aims of the present study were to see the efficacy of UST on calcific tendonitis. This was a prospective study done at BSMMU, BIRDEM and Rangpur Medical College Hospital. All the cases with duration of illness more than three months, and diameter of stones more than 5mm were included in this study. Out of 26 cases 10(38%) were male, 14(54%) were housewife, 8(31%) were businessmen. UST were given to all cases for 10 minute with 1 to 1.5 W/sq cm for 12 doses. After 12 doses of UST all the patients became free from pain and restriction of movements. Radiographs of 24(92%) cases showed no calculi. Only two patients showed clinical improvement only but radiographs showed no change in caiculi and symptoms returned after one and two months respectively.