Résumé
INTRODUCTION: Shoulder pain after stroke, a complication with a prevalence of up to 1684% usually occurs after 23 months and leads to patients withdrawing from rehabilitation programs, staying in the hospital longer, having less limb function and having a great negative impact on their quality of life. The aim of the present study was to determine the effect of PEMF and NMES in reducing shoulder pain in patients with stroke. MATERIAL AND METHODS: A prospective, randomized controlled trial included 51 patients with shoulder pain following stroke. The patients were randomly assigned to three groups (17 people in each group): Pulsed Electromagnetic Field (PEMF), Neuromuscular Electrical Stimulation (NMES) and Control group. The outcome measures were Visual Analogue Scale (VAS), Modified Ashworth Scale (MAS) and Fugl Meyer AssessmentUpper Extremity (FMA-UE), Active and Passive Range of Motion (AROM/PROM) assessed at the baseline, six weeks into the intervention, and one week into the follow-up. RESULTS: VAS score for pain showed a mean change of 1.60, 1.60 and 4.94 in PEMF, NMES, and control respectively after 20 sessions. It showed pain was significantly improved in all the groups (p<0.001), but the effectiveness of the PEMF and NMES groups was superior to the control group. CONCLUSION: The current literature showed that PEMF & NMES are effective in improving post-stroke shoulder pain, spasticity, range of motion and motor function and a novel method for stroke patients undergoing rehabilitation.
INTRODUÇÃO: Dor no ombro após acidente vascular cerebral com prevalência de 1684% geralmente ocorre após 23 meses e pode resultar na suspensão de programas de reabilitação, internações hospitalares mais longas e redução da função dos membros, prejudicando qualidade de vida dos pacientes com AVC. O objetivo do presente estudo foi determinar o efeito da PEMF e da EENM na redução da dor no ombro em pacientes com acidente vascular cerebral. MATERIAL E MÉTODOS: Um estudo prospectivo, randomizado e controlado incluiu 51 pacientes com dor no ombro pós-AVC. Os pacientes foram divididos aleatoriamente em três grupos (17 pessoas em cada grupo): grupo Campo Eletromagnético Pulsado (PEMF), grupo Estimulação Elétrica Neuromuscular (EENM) e grupo Controle. As medidas de resultados foram na Escala Visual Analógica (VAS), Escala de Ashworth Modificada (MAS) e Avaliação de Fugl Meyer Extremidade Superior (FMA-UE), Amplitude de Movimento (AROM/PROM) foram avaliadas no início do estudo, após seis semanas de tratamento, e após um acompanhamento semanal. RESULTADOS: A pontuação VAS para dor mostrada uma alteração média de 1,60, 1,60 e 4,94 na PEMF, EENM e Controle, respectivamente, após 20 sessões. Mostrou melhora significativa entre os três grupos (p<0,001), mas a eficácia do grupo PEMF e EENM foi superior ao grupo Controle. CONCLUSÃO: O presente estudo mostrou que PEMF e EENM são eficazes na melhora da dor no ombro pós-AVC, espasticidade, amplitude de movimento e função motora e um novo método para pacientes com AVC em reabilitação. Nossas descobertas indicam que a eficácia da EENM é claramente superior à do PEMF na manutenção da analgesia a longo prazo.
Sujets)
Accident vasculaire cérébral , Scapulalgie , Stimulation électriqueRésumé
Objective@#To explore the association among neck-shoulder pain (NSP), low back pain (LBP) and co occurring symptoms with mental sub health in adolescents, so as to provide evidence for improving physical and mental health of adolescents.@*Methods@#Stratified cluster random sampling method was used to select 7 986 students from 12 middle and high schools in Shenzhen, Nanchang, and Shenyang cities from October to December 2019. The Assessment of Spinal Health of Youth (ASHY) and the Brief Instrument on Psychological Health of Youth (BIOPHY) were used to assess NSP, LBP and mental sub health. Binary Logistic regression model was used to analyze the association between NSP, LBP and co occurring symptoms with mental sub health in adolescents.@*Results@#The detection rates of adolescents with NSP, LBP and co occurring symptoms and mental sub health were 9.1% , 9.8%, 9.5%, and 10.0%, respectively. The co occurring rate of neck shoulder pain, low back pain and mental sub health was 3.2%. After adjusting for confounding variables such as gender, age, being an only child, family residence, and parental education level, NSP ( OR=6.01, 95%CI =5.02-7.19), LBP ( OR=5.08, 95%CI =4.25-6.07), and co occurring symptoms ( OR= 5.96 , 95%CI =4.98-7.12) in adolescents were positively correlated with mental sub health risk ( P <0.01). Stratifying the gender, boys with NSP, LBP and co occurring symptoms ( OR =6.84, 5.80, 6.74)had a higher risk of mental sub health compared to girls ( OR =5.52, 4.65, 5.49) ( P <0.01).@*Conclusions@#NSP, LBP and co occurring symptoms in adolescents are associated with mental sub health. The mental health status of boys is more affected by NSP, LBP and their co occurring symptoms. Measures should be taken to improve spinal health in adolescents to reduce the incidence of mental sub health.
Résumé
Objective To investigate the effect of right stellate ganglion block(SGB)on postoper-ative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 pa-tients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA phys-ical status Ⅰ orⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n = 51)and the control group(group C,n = 53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were re-corded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T1),2 hours after operation(T2),6 hours after operation(T3),12 hours after operation(T4),24 hours after operation(T5),and 48 hours after operation(T6).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P<0.05),and the degree of PLSP in group S was significantly lower than that in group C at T3-T5(P<0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P<0.05).The incidence of nausea in group S was significantly lower than that in group C(P<0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.
Résumé
BACKGROUND:In clinical work,the stiffness of neck soft tissue in patients with neck and shoulder pain is mainly detected through palpation,which is highly subjective and lacks an objective basis.Real-time shear wave elastography is a quantitative elastic ultrasound technique that can objectively assess muscle elasticity and muscle status. OBJECTIVE:To apply real-time shear wave elastography to assess the stiffness of scalene muscles in patients with neck and shoulder pain and to observe the characteristics of muscle stiffness changes in the bilateral anterior,middle and posterior scalene muscles in patients with neck and shoulder pain. METHODS:From December 2021 to June 2022,36 healthy subjects(control group)and 36 patients with neck and shoulder pain(test group)were recruited at the Shenzhen Hospital of Guangzhou University of Chinese Medicine.Real-time shear wave elastography was applied to measure the mean values of elastic modulus and cross-sectional area of the anterior and middle and posterior scalene muscles bilaterally in the neutral and lateral flexion positions of the neck in both groups. RESULTS AND CONCLUSION:In the same position,there were no significant differences between the mean Values of elastic modulus of the left and right anterior scalene muscles as well as between the mean Values of elastic modulus of the left and right middle scalene muscles in each group(P>0.05);there were no significant differences between the cross-sectional area of the left and right anterior scalene muscles as well as the cross-sectional area of the left and right posteromedial scalene muscles in each group(P>0.05);and the elastic modulus and cross-sectional area of the posteromedial scalene muscles were significantly higher than those of the anterior scalene muscles in both groups(P<0.01,P<0.001).The mean Values of elastic modulus of the anterior and posteromedial scalene muscles were higher in the test group than in the control group in the neutral and lateral neck flexion positions(P<0.001),while the cross-sectional areas of the anterior and posteromedial scalene muscles were lower than those in the control group(P<0.01,P<0.001).To conclude,real-time shear wave elastography can be used to visually evaluate the differences in the mean Values of elastic modulus of the anterior and posteromedial scalene muscles in different states of the neck muscles in patients with neck and shoulder pain,whose bilateral scalene muscles are in a state of strain and stiffness.
Résumé
ObjectiveTo observe the effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia. MethodsFrom January, 2020 to November, 2021, 43 patients with hemiplegia after stroke in the Second People's Hospital of Nantong were randomly divided into control group (n = 21) and treatment group (n = 22). The control group received shoulder control training, while the treatment group received neural mobilization in addition. Before and after four weeks of treatment, they were evaluated with the Numeric Rating Scale (NRS) of pain and Fugl-Meyer Assessment-Upper Extremities (FMA-UE). ResultsOne case dropped off in the control group and two cases dropped off in the treatment group. After treatment, the NRS score and FMA-UE score improved in both groups (|t| >7.898, P < 0.001), and they were better in the treatment group than in the control group (|t| >2.337, P < 0.05). ConclusionNeural mobilization based on shoulder control training can significantly alleviate shoulder pain and improve upper limb motor function in stroke patients with hemiplegia.
Résumé
Abstract Background and objectives: Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting. Methods: Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient's motor function improvement. The secondary outcome was patient satisfaction. Results: A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient's global impression of change superior to six. Conclusion: This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients' satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.
Résumé
ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder pain is a limiting condition that has a major impact on daily activities and work. Knowing which specific activities involving the shoulder are associated with the occurrence of higher levels of pain may be of interest to professionals. The use of images of shoulder movements can be an effective tool to check the presence of pain and fear of movement, break down language and cultural barriers, and facilitate communication between professional and patient. The objectives of this study were: (1) to carry out a descriptive analysis of fear responses and movement avoidance based on passive viewing of images of shoulder movements based on the International Classification of Functioning, Disability and Health (ICF) codes; (2) to check whether there is a correlation between fear responses and movement avoidance with the Shoulder Pain and Disability Index (SPADI). METHODS: In this cross-sectional observational study, individuals with chronic shoulder pain were recruited. Participants responded to the Shoulder Pain and Disability Index (SPADI) and the TAMPA Scale of Kinesiophobia (TSK) to measure the intensity of shoulder pain and disability, and fear of movement, respectively. Participants viewed 58 movement images based on codes and descriptors from the third chapter of ICF. In addition, they responded to a numerical scale to judge fear of movement and a second numerical scale to judge movement avoidance. RESULTS: The study included 42 individuals. The activities belonging to the mobility subgroup (chapter 4), which refers to chapter 3 of the ICF, are those that present greater responses of fear and movement avoidance. Multiple regression resulted in a significant model [F(1, 40) = 31.119; p<0.001; R2 = 0.438], when verifying whether fear and movement avoidance responses related to ICF images are associated with SPADI in participants with chronic shoulder pain. The fear response is associated with SPADI (β=0.661; t=5.578; p<0.001), however, the avoidance response did not present a significant result with the scale (β=−0.063; t=-0.160; p=0.874). CONCLUSION: Movements that refer to mobility seem to be the most feared and avoided by people with chronic shoulder pain. Fear of movement is associated with shoulder disability.
RESUMO JUSTIFICATIVA E OBJETIVOS: A dor no ombro é uma condição limitante, que apresenta grande impacto nas atividades de vida diárias e no trabalho. Conhecer quais atividades específicas envolvendo o ombro estão associadas à ocorrência de maiores níveis de dor pode ser de interesse dos profissionais. A utilização de imagens de movimentos do ombro pode ser uma ferramenta eficaz para verificar a presença de dor e medo de movimento, quebrar barreiras de linguagem e culturais e facilitar a comunicação entre profissional e paciente. Os objetivos deste estudo foram: (1) realizar a análise descritiva das respostas de medo e evitação do movimento a partir da visualização passiva de imagens de movimentos do ombro baseadas nos códigos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF); (2) verificar se há correlação das respostas de medo e evitação do movimento com o Índice de dor e Incapacidade do Ombro (SPADI). METODOS: Neste estudo observacional do tipo transversal foram recrutadas pessoas com dor crônica no ombro. Os participantes responderam ao Shoulder Pain and Disability Index (SPADI) e à Escala TAMPA de Cinesiofobia (TSK) para mensurar a intensidade da dor e incapacidade do ombro, e de medo do movimento, respectivamente. Os participantes visualizaram 58 imagens de movimentos baseadas em códigos e descritores do terceiro capítulo de Atividade e Participação da CIF. Além disso, responderam a uma escala numérica para julgar o medo do movimento e a uma segunda escala numérica para julgar a evitação ao movimento. RESULTADOS: Participaram do estudo 42 pessoas. As atividades pertencentes ao subgrupo mobilidade (capítulo 4), referente ao capítulo 3 da CIF, são as que apresentam maiores respostas de medo e evitação do movimento. A regressão múltipla resultou em um modelo significativo [F (1, 40) = 31, 119; p<0,001; R2 = 0,438], ao verificar se as respostas de medo e evitação do movimento referente às imagens da CIF estão associadas ao SPADI dos participantes com dor crônica no ombro. A resposta de medo é associada ao SPADI (β=0,661; t=5,578; p<0,001), porém a resposta de evitação não apresentou resultado significativo com a escala (β=−0,063; t=−0,160; p=0,874). CONCLUSÃO: Os movimentos que se referem à mobilidade parecem ser os mais temidos e evitados por pessoas com dor crônica no ombro. O medo do movimento está associado com a incapacidade do ombro.
Résumé
ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder painful dysfunctions comprises one of the most common musculoskeletal disorders that requires specialized assistance. Dry Needling (DN) became an adjuvant approach with increased use in clinical practice to treat this type of condition. The present study discusses the literature related to DN in the treatment of myofascial trigger points (MTPs), shoulder dysfunctions and associated pain. METHODS: A narrative review through search of articles from 2010 to 2022 written in Portuguese, English or Spanish was performed in Latin American and Caribbean Literature on Health Sciences (LILACS), Health Information from the National Library of Medicine (Medline), Web of Science and the Scientific Electronic Library Online (Scielo) databases using the keywords: <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <"Shoulder Dysfunctions">; <"Disfunções do ombro">. The qualitative analysis was performed determining the level of evidence for DN treatment of MTPs, shoulder dysfunctions and pain. RESULTS: A total of 45 citations were found, 22 citations were excluded because they did not meet the selection criteria. The 23 remaining citations were examined for titles and abstracts and duplicate studies were removed. Finally, 10 articles met the selection criteria and were included in the present review. No articles were excluded after full-text screening. The analysis showed poor advances and knowledge regarding the application of DN for the treatment of pain, painful and general shoulder dysfunctions and MTPs, with few evidence regarding treatment effectiveness, patient's pain scores data, mechanisms of action and statistical analysis. CONCLUSION: There is still a lack of concrete scientific evidence to assess DN effectiveness in modulating pain in patients with MTPs shoulder. More systematic reviews and meta-analyses together with experimental and clinical searches must be conducted to provide stronger evidence of this modality to relief painful symptoms in the shoulder, as well as a treatment of MTPs and general shoulder disorders.
RESUMO JUSTIFICATIVA E OBJETIVOS: As disfunções dolorosas de ombro constituem uma das disfunções musculoesqueléticas mais comuns que requerem assistência especializada. O agulhamento a seco (AS) tornou-se uma abordagem adjuvante com uso crescente na prática clínica para tratar esse tipo de condição. O objetivo deste estudo foi rever na literatura aspectos relacionados ao AS no tratamento de pontos-gatilho miofasciais (PGMs), disfunções do ombro e dores associadas. MÉTODOS: Foi realizada uma revisão narrativa através da busca de artigos de 2010 a 2022 escritos em português, inglês ou espanhol, na Literatura Latino-Americana e do Caribe nos bancos de dado Ciências da Saúde (LILACS), Informações em Saúde da Biblioteca Nacional de Medicina (Medline), Web of Science e Scientific Electronic Library Online (Scielo) utilizando as palavras-chave <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <" Disfunções do ombro">. A análise qualitativa foi realizada determinando o nível de evidência para tratamento de AS para o tratamento de PGMs, disfunções do ombro e dor. RESULTADOS: Um total de 45 citações foram encontradas, 22 citações foram excluídas porque não atenderam aos critérios de seleção. As 23 citações restantes foram examinadas para títulos e resumos e estudos duplicados foram removidos. Finalmente, 10 artigos atenderam aos critérios de seleção e foram incluídos na presente revisão. Nenhum artigo foi excluído após a triagem de texto completo. A análise mostrou poucos avanço e conhecimento sobre a aplicação de AS para o tratamento da dor, disfunções dolorosas e gerais do ombro e PGMs, com poucas evidências sobre a eficácia do tratamento, dados dos escores de dor do paciente, mecanismos de ação e análise estatística. CONCLUSÃO: Ainda faltam evidências científicas concretas para avaliar a eficácia do AS na modulação da dor em pacientes com PGMs no ombro. Mais revisões sistemáticas e meta-análises associadas a pesquisas experimentais e clínicas devem ser realizadas para fornecer evidências dessa modalidade promissora para alívio de sintomas dolorosos no ombro, bem como tratamento de PGMs e distúrbios gerais do ombro.
Résumé
Introducción. Actualmente existe un aumento considerable de lesiones de miembros superiores en trabajadores con labores de escritorio y trabajo de escritorio. Una de las lesiones más comunes es el DHRMR (Dolor de Hombro Relacionado al Manguito Rotador).1,2 Por esta razón, la presente investigación buscó intervenir un grupo de trabajadores de oficina de la Universidad de Las Américas, campus Santiago Centro con dolor de hombro3, realizando pausas activas (PA), y ejercicios focalizados que buscaban aliviar el dolor y aumentar la funcionalidad. Objetivo. Comparar las PA basadas en ejercicios de fuerza, versus, las PA basadas en ejercicios de flexibilidad sobre las variables de función de hombro, dolor, dinamometría y síntomas asociados a sospecha de ansiedad y depresión en trabajadores administrativo de la Universidad de Las Américas, campus Santiago Centro. Métodos. Estudio pseudo-experimental, simple ciego (individuos no conocen a que grupo pertenecen), 40 participante mayores de 18 años que presentaron dolor de hombro en un periodo de 6 meses. Para la evaluación se utilizaron escalas DASH, ASES, EVA y GOLDBERG. Se separaron en dos grupos, grupo de ejercicios de fuerza y un grupo de ejercicios de flexibilidad, la aleatorización de los participantes en cada grupo se realizó con el software OxMaR. Resultados. Se observaron en todas las variables que no existieron diferencias significativas entre ambos grupos. Conclusión. No se observaron mayores diferencias entre ambas intervenciones, con una tendencia a una mayor mejoría al grupo de fuerza.
Background. Currently there is a considerable increase in upper limb injuries in workers with desk and teleworking tasks. One of the most common injuries is the DHRMR (Shoulder Pain Related to the Rotator Cuff).1,2 For this reason, the present investigation sought to intervene a group of office workers with shoulder pain3, performing active pauses (PA), and focused exercises that sought to relieve pain and increase functionality. Objective. To compare BP based on strength exercises versus BP based on flexibility exercises on the variables of shoulder function, pain, dynamometry, and symptoms associated with suspicion of anxiety and depression. Methods. Single-blind clinical trial, 40 subjects over 18 years of age who presented shoulder pain in a period of 6 months. For the evaluation, DASH, ASES, EVA and GOLDBERG scales were used. They were separated into two groups, a strength exercise group and a flexibility exercise group. Results. It was observed in all the variables that there were no significant differences between both groups. Conclusion. No major differences were observed between the two interventions, with a tendency to a greater improvement in the strength group.
Résumé
ABSTRACT BACKGROUND AND OBJECTIVES: Home-based exercises can improve function and quality of life in shoulder pain patients. Knowing the facilitators and barriers is crucial for adherence to shoulder pain treatment. It is believed that individuals who adhere to home exercises have fewer environmental barriers, pain intensity and shoulder disability. The aim of this study is to identify facilitators and barriers for adherence to a home-based exercise program in shoulder pain individuals, and to investigate the influence of environmental barriers, shoulder pain and disability, and kinesiophobia on adherence to a program. METHODS: This is a cross-sectional study. Shoulder pain individuals performed home-based exercises for eight weeks based on a booklet in addition to supervised physical therapy or as their sole therapy. They reported the perceived facilitators and barriers to home exercises adherence and answered the Craig Hospital Inventory of Environmental Factors (CHIEF), Shoulder Pain and Disability Index (SPADI), and the Tampa Scale for Kinesiophobia (TSK) questionnaires. Logistic regression models analyzed the scores of the CHIEF, SPADI, and TSK as predictors of adherence. RESULTS: Fifty individuals participated in this study and 88% adhered to the program. The most frequent facilitator and barrier were "having guidance from a professional," and "lack of available time," respectively. Pain and disability were the only predictor of adherence (p=0.044), and an increase of one point in SPADI reduced the likelihood of adherence to home exercises by 14% (Exp(B) =0.86). CONCLUSION: Individuals reported facilitators and barriers to the exercise program. Environmental barriers assessed using the CHIEF and kinesiophobia were not predictors of adherence.
RESUMO JUSTIFICATIVA E OBJETIVOS: Os exercícios domiciliares podem melhorar a função e a qualidade de vida de pacientes com dor no ombro. Conhecer facilitadores e barreiras é fundamental para adesão ao tratamento da dor no ombro. Acredita-se que indivíduos que aderem aos exercícios domiciliares apresentem poucas barreiras ambientais, baixa intensidade de dor e incapacidade do ombro. O objetivo deste estudo foi identificar facilitadores e barreiras para a adesão a um programa de exercícios domiciliares em indivíduos com dor no ombro e investigar a influência de barreiras ambientais, da dor e incapacidade no ombro, e da cinesiofobia na adesão ao programa. MÉTODOS: Neste estudo transversal, indivíduos com dor no ombro realizaram exercícios domiciliares por oito semanas com base em uma cartilha além da fisioterapia supervisionada ou como sua única terapia. Os indivíduos relataram facilitadores e barreiras percebidos para a adesão aos exercícios em casa e responderam ao Craig Hospital Inventory of Environmental Factors-Brasil (CHIEF-Br), Shoulder Pain and Disability Index-Brasil (SPADI-Br) e Escala Tampa de Cinesiofobia (TAMPA). Os escores do CHIEF-Br, SPADI-Br e TAMPA foram analisados como preditores de adesão por meio de modelos de regressão logística. RESULTADOS: Participaram do estudo 50 indivíduos e 88% aderiram ao programa. O facilitador e a barreira mais frequentes foram "receber orientação de um profissional" e "falta de tempo disponível", respectivamente. Dor e incapacidade foram os únicos preditores de adesão (p=0,044), e o aumento de um ponto no SPADI-Br reduziu a probabilidade de adesão aos exercícios domiciliares em 14% (Exp(B) =0,86). CONCLUSÃO: Os indivíduos relataram facilitadores e barreiras ao programa de exercícios. A barreiras ambientais avaliadas por meio do CHIEF-Br e a cinesiofobia não foram preditores da adesão.
Résumé
Objective:To observe the clinical efficacy of combining contralateral needling and tendon-bone balancing Tuina(Chinese therapeutic massage)in treating scapulohumeral periarthritis(SP). Methods:Sixty-eight eligible participants were chosen and randomized into an acupuncture group and an acupuncture plus Tuina group,with 34 cases in each group.The acupuncture group received treatment with contralateral needling,and the acupuncture plus Tuina group was treated with contralateral needling combined with tendon-bone balancing Tuina.The post-treatment changes in the Constant-Murley score for comprehensive shoulder function,visual analog scale(VAS)score for pain,and shoulder range of motion(ROM)score were compared after 2 treatment courses to estimate the clinical efficacy in the two groups. Results:After treatment,the total effective rate was 96.7%in the acupuncture plus Tuina group versus 83.9%in the acupuncture group,showing a significant difference between the two groups(P<0.05).The Constant-Murley shoulder function score increased in the acupuncture plus Tuina group after the intervention;a decreased VAS pain score and an increased shoulder ROM score were found in both groups.After 1 and 2 treatment courses,the between-group comparisons of the Constant-Murley and shoulder ROM scores showed statistical significance(P<0.05).Regarding the VAS score,the acupuncture plus Tuina group was lower than the acupuncture group after the first treatment course(P<0.05),but there was no significant difference between the two groups after 2 treatment courses(P>0.05). Conclusion:Contralateral needling plus tendon-bone balancing Tuina can produce more significant clinical efficacy and relieve pain faster than contralateral needling alone in treating SP.
Résumé
Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.
Résumé
Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation on hemiplegic shoulder pain during convalescence of stroke.Methods A total of 40 patients with hemiplegic shoulder pain during convalescing stroke who were hospitalized in Rehabilitation Medicine Department of Jiaxing Second Hospital from January 2021 to June 2022 were selected and randomly divided into treatment group(rTMS group)and control group(sham rTMS group),with 20 cases in each group.Both groups were given anti-inflammatory and analgesic drugs and conventional rehabilitation treatment.On this basis,the treatment group was combined with rTMS treatment(stimulation frequency was 10.0Hz,stimulation intensity was 80%resting motor threshold,stimulation time was 10s,interval was 50s,total treatment time was 20 minutes,once a day from Monday to Friday,continued treatment 2 days apart,20 times as a course of treatment,a total of 4 weeks),while the control group received sham rTMS.Before treatment,2 and 4 weeks after treatment,numerical pain rating scale(NPRS)was used to assess the degree of shoulder pain,passive shoulder range of motion was measured by protractor,upper limb motor function of hemiplegic side was assessed by Fugl Meyer assessment upper extremity(FMA-UE),and the ability of daily living activities was assessed by modified Barthel index(MBI).Results After treatment,NPRS score of shoulder pain in 2 groups was significantly decreased compared with before treatment(P<0.001),passive shoulder motion and Fugl-Meyer upper limb motor function were significantly improved compared with before treatment(P<0.001),and the treatment group was significantly better than the control group,the difference between groups was statistically significant(P<0.05).The modified Barthel index in 2 groups was significantly improved compared with before treatment(P<0.001),but there was no statistical significance between 2 groups(P>0.05).Conclusion 10.0Hz high-frequency repetitive transcranial magnetic stimulation can significantly relieve hemiplegic shoulder pain during the convalession of stroke,improve the passive range of motion of the affected shoulder,and improve the upper limb motor function of the affected side,but the effect is not significant in improving the ability of daily living activities.
Résumé
OBJECTIVE@#To observe the clinical efficacy on hemiplegic shoulder pain (HSP) after stroke treated with electroacupuncture (EA) under different frequencies.@*METHODS@#A total of 105 patients with HSP after stroke were randomly divided into a manual acupuncture group (35 cases, 2 cases dropped off), an EA continuous wave group (35 cases, 3 cases dropped off) and an EA disperse-dense wave group (35 cases). The conventional rehabilitation therapy was delivered in the three groups. Additionally, acupuncture was applied to Jianyu (LI 15), Jianzhen (SI 9), Jianliao (TE 14) and Jianqian (Extra) etc. on the affected side in the manual acupuncture group. In the EA continuous wave group and the EA disperse-dense wave group, besides the treatment as the manual acupuncture group, the electric stimulation was attached to two pairs of acupoints, i.e. Jianyu (LI 15) and Jianliao (TE 14), and Quchi (LI 11) and Shousanli (LI 10), with 15 Hz continuous wave, and 2 Hz/ 100 Hz disperse-dense wave, respectively. The treatment was given once daily, 5 times a week, for 4 weeks consecutively. The score of visual analogue scale (VAS) before treatment and after 2 and 4 weeks of treatment, as well as the passive range of motion (PROM) of shoulder forward flexion and PROM of shoulder abduction, muscle strength of the upper limb, the score of modified Barthel index (MBI) and the score of Fugl-Meyer assessment (FMA) before and after treatment were observed in each group.@*RESULTS@#Compared with before treatment, VAS scores were reduced after 2 and 4 weeks of treatment in each group (P<0.05); and VAS scores after 4 weeks of treatment were lower than those after 2 weeks of treatment (P<0.05). After 2 and 4 weeks of treatment, VAS score in either the EA continuous wave group or the EA disperse-dense wave group was lower compared with the manual acupuncture group (P<0.05). After 4 weeks of treatment, VAS score in the EA disperse-dense wave was lower than that of the EA continuous wave group (P<0.05). Compared with before treatment, PROM of the shoulder forward flexion and abduction on the affected side after treatment was enlarged (P<0.05), the muscle strength of the upper limb was increased (P<0.05), and the scores of MBI and FMA were increased (P<0.05) in the patients of each group. After treatment, in the EA continuous wave group and the EA disperse-dense wave group, PROM of the shoulder forward flexion on the affected side was higher (P<0.05), the muscle strength of the upper limb was stronger (P<0.05) when compared with the manual acupuncture group; and the scores of MBI and FMA in the EA disperse-dense wave group were higher than those of the manual acupuncture group (P<0.05).@*CONCLUSION@#Electroacupuncture is superior to manual acupuncture in the analgesic effect and comprehensive rehabilitation effect in the patients with HSP after stroke. The therapeutic effect obtained by electroacupuncture with 2 Hz/100 Hz disperse-dense wave is better than that with 15 Hz continuous wave.
Sujets)
Humains , Électroacupuncture , Scapulalgie/thérapie , Hémiplégie/thérapie , Accident vasculaire cérébral/complications , Thérapie par acupuncture , Résultat thérapeutique , Points d'acupunctureRésumé
OBJECTIVES@#To observe the effects of acupoint application with turmeric blistering moxibustion plaster on pain, shoulder range of motion (ROM) and upper limb motor function in the patients with post-stroke hemiplegic shoulder pain (PSHSP).@*METHODS@#Eighty-two patients with PSHSP were randomly divided into an observation group (41 cases, 1 case was eliminated, 4 cases dropped out) and a control group (41 cases, 2 cases were eliminated and 2 cases dropped out). The routine treatment, nursing care and rehabilitation training were performed in the control group. On the basis of the intervention as the control group, in the observation group, the turmeric blistering moxibustion plaster was applied to bilateral ashi points, Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14), Shousanli (LI 10) and Hegu (LI 4), once a day, remained for 6 hours each time. This moxibustion therapy was operated 5 times weekly, one course of treatment consisted of 2 weeks and 2 courses were required. Separately, before treatment and after 2 and 4 weeks of treatment, the score of visual analogue scale (VAS), shoulder ROM and the score of upper limbs in Fugl-Meyer assessment (U-FMA) were observed in the two groups.@*RESULTS@#VAS scores were lower (P<0.05), ROM in shoulder flexion, abduction, internal rotation and external rotation was larger (P<0.05), and U-FMA scores were higher (P<0.05) after 2 and 4 weeks of treatment when compared with those before treatment in the two groups. After 4 weeks of treatment, VAS score decreased (P<0.05), and ROM in shoulder flexion, abduction, internal rotation, external rotation and U-FMA score increased (P<0.05) in comparison with those after 2 weeks of treatment in either group. In the observation group, VAS scores were dropped (P<0.05) after 2 and 4 weeks of treatment respectively, and ROM of shoulder flexion and abduction enlarged after 2 weeks of treatment (P<0.05) when compared with those in the control group. After 4 weeks of treatment, ROM in shoulder flexion, abduction, internal rotation and external rotation in the observation group was larger (P<0.05) and U-FMA score was higher (P<0.05) than those in the control group.@*CONCLUSIONS@#Acupoint application with turmeric blistering moxibustion plaster may effectively reduce the degree of shoulder pain and improve the shoulder range of motion and the upper limb motor function in the patients with post-stroke hemiplegic shoulder pain.
Sujets)
Humains , Épaule , Moxibustion , Scapulalgie/thérapie , Points d'acupuncture , Curcuma , Hémiplégie/thérapie , Résultat thérapeutiqueRésumé
Abstract Objective The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions. Methods Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty. Results In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation (p< 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation (p= 0.027) and Constant score (p= 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision. Conclusion Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.
Resumo Objetivo Avaliar os resultados clínicos da artroplastia reversa do ombro no tratamento de suas diversas indicações. Métodos Estudo longitudinal retrospectivo que analisou os resultados dos escores Constant, UCLA e amplitudes de movimentos dos pacientes submetidos à artroplastia reversa do ombro. Resultados Foram analisados 28 pacientes, a média de idade foi de 75.6 anos, com seguimento médio de 45 meses. No geral, obtivemos uma variação significativa (p< 0,0001) entre o escore UCLA pré-operatório (10,2 pontos) e o escore UCLA pós-operatório (29,6 pontos), o que corresponde a um aumento relativo de aproximadamente 200%. Além disso, obtivemos pontuação média do escore Constant de 67,8 e uma taxa de complicações de 17,8%. Quanto aos resultados funcionais segundo as indicações, os casos de sequela de fratura apresentaram as melhores médias de elevação (165°), escore Constant (79 pontos), escore UCLA pós-operatório (32,5 pontos) e aumento absoluto na variação do escore UCLA (22 pontos), sem significância estatística. Porém, identificou-se que os casos operados por sequela de fratura apresentaram elevação (p= 0,027) e pontuação no escore Constant (p= 0,047) significativamente maiores em relação aos casos de artropatia do manguito rotador. Além disso, observamos que as menores médias dos escores Constant e UCLA pós-operatórios foram obtidos nas seguintes etiologias: artrose primária, fratura aguda e revisão de artroplastia. Conclusão A artroplastia reversa de ombro apresentou resultados funcionais satisfatórios, podendo ser uma opção de tratamento não somente nos casos de artropatia do manguito rotador, mas também em várias outras patologias.
Sujets)
Humains , Mâle , Femelle , Épaule/physiopathologie , Lésions de la coiffe des rotateurs , Arthroplastie de l'épauleRésumé
ABSTRACT BACKGROUND AND OBJECTIVES: In volleyball, the high demand for shoulder sports makes it susceptible to injuries due to the repetition of sporting gestures. The presence of pain in the shoulder can lead to the disability to perform movements correctly, resulting in reduced sports performance. The study aimed to evaluate and correlate the presence of pain and functional disability of the upper extremity in volleyball athletes. METHODS: Cross-sectional descriptive study, developed with 30 female volleyball athletes. Functional disability was assessed using the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and pain intensity using the Visual Numeric Scale (VNS). The study was conducted in an online format. The IBM SPSS 21.0 statistical package for Windows was used, where descriptive measures, Wilcoxon, and Spearman correlation tests were performed, adopting p≤0.05. RESULTS: Nineteen athletes reported mild to moderate pain to perform daily activities, and 21 athletes reported pain to perform sporting gestures, with pain being significantly more intense in the dominant shoulder in the spike movement (p<0.001), serve (p<0.001), and blocking (p=0.03). Athletes did not present functional limitations in the DASH, but the opposite, outside hitter, and middle blocker, presented mild limitations in the DASH sport. There was a strong correlation between DASH and day-to-day pain (rs=0.79; p<0.001) and a moderate correlation between sports DASH and pain in the dominant shoulder in the spike (rs=0.67; p<0.001) and in the serve (rs=0.60; p<0.001) movements. CONCLUSION: Evaluated athletes presented shoulder pain, higher functional disability to performer the sports activity, and pain and functional disability were positively correlated HIGHLIGHTS Overhead movements such as serve and spike contribute to shoulder pain in volleyball players; The functional disability of the upper limbs is positively correlated with the intensity of pain to perform daily activities and sports; The kinetic-functional diagnosis is important to minimize the risk of injury, rehabilitate injured athletes and provide an adequate return of the athlete to sports practice.
RESUMO JUSTIFICATIVA E OBJETIVOS: No voleibol, a alta exigência da articulação do ombro torna-o suscetível a lesões devido à repetição dos gestos esportivos. A presença de dor no ombro pode gerar incapacidade para executar os movimentos corretamente, ocasionando redução do desempenho esportivo. O estudo teve como objetivo avaliar e correlacionar a presença de dor e incapacidade funcional de membro superior em atletas de voleibol. METODOS: Estudo transversal, descritivo, desenvolvido com 30 mulheres atletas de voleibol de quadra. A incapacidade funcional foi avaliada por meio do Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) e a intensidade de dor pela Escala Visual Numérica (EVN) de 10 pontos. A pesquisa foi conduzida no formato on-line. Utilizou-se o programa estatístico IBM SPSS 21.0 para Windows, pelo qual foram realizadas as medidas descritivas, o teste de Wilcoxon e a correlação de Spearman adotando p≤0,05. RESULTADOS: Dezenove atletas relataram dor leve a moderada para realizar as atividades diárias, e 21 atletas para realizar os gestos esportivos, sendo a dor significativamente mais intensa no ombro dominante em movimentos para ataque (p<0,001), saque (p<0,001) e bloqueio (p=0,03). As atletas não apresentaram limitação funcional no DASH geral, mas no DASH esporte as opostas, ponteiras e centrais foram classificadas com limitação leve. Houve correlação forte entre DASH e dor no dia a dia (rs=0,79; p<0,001) e correlação moderada entre DASH esporte e dor no ombro dominante no ataque (rs=0,67; p<0,001) e no saque (rs=0,60; p<0,001). CONCLUSAO: Atletas avaliadas apresentaram dor no ombro, maior incapacidade funcional na atividade esportiva, e dor e incapacidade funcional estavam positivamente correlacionadas. DESTAQUES Movimentos aéreos como saque e ataque contribuem para a dor no ombro em jogadores de voleibol; A incapacidade funcional dos membros superiores correlaciona-se positivamente com a intensidade da dor para a realização de atividades cotidianas e esportivas; O diagnóstico cinético-funcional é importante para minimizar o risco de lesão, reabilitar atletas lesionados e proporcionar um retorno adequado do atleta à prática esportiva.
Résumé
Shoulder pain is a common complaint in the wheelchair user's population. This condition brings loss of independence and quality of life. Objective: The aim of this paper is to correlate shoulder joint isokinetic parameters and independence level of manual wheelchair users with or without pain. We hypothesize that users more independent are exposed to overuse injury of shoulder joints. Method: This is an explorative cross-sectional study with a quantitative approach. Community patients attended at a Rehabilitation Center. Manual wheelchair users. Twenty-four patients participated, we used the Functional Independence Measurement (FIM) to investigate the independent level of wheeled patients and isokinetic parameters of internal/external rotators and flexion/extension muscles of shoulder joint was collected using Biodex System 4 Pro. Statistical analyses were made by Fisher Test, Spiro-Wilk Test, Pearson Correlation test, Spearman test and the Coefficient of correlation's value was squared to estimate the percentage of variation in dependent variable, explained by independent variable. Results: Total FIM variation was between 79 and 117 and median ipsilateral strength ratio of rotator muscles were 0.94 on 75°/s and 0.95 on 150°/s for the right limb and respectively 0.96 and 0.93 for the left limb. Conclusion: Wheelchair users present internal/external rotators shoulder muscles imbalance and the covariations samples of time of injury and peak torque ratio external/internal shoulder rotators have a significant predictive value on total MIF. These results suggest that there is correlation between the studied patients and shoulder impairment.
Dor no ombro é uma queixa comum na população de usuários de cadeira de rodas. Esta condição acarreta perda de independência e de qualidade de vida. Objetivo: Correlacionar parâmetros isocinéticos da articulação do ombro com níveis de independência de usuários de cadeira de rodas manual com e sem dores. Nossa hipótese é que usuários mais independentes estão mais expostos à lesões em ombros por sobrecarga. Método: Trata-se de um estudo exploratório transversal com abordagem quantitativa. Foram avaliados pacientes oriundos da comunidade, usuários de cadeira de rodas manual atendidos em um centro de reabilitação. Participaram do estudo vinte e quatro indivíduos e foram utilizados os instrumentos: Medida de Independência Funcional (MIF); parâmetros isocinéticos de rotadores interno/externo e flexor/extensor da articulação de ombro coletados usando Biodex System 4 Pro. Análises estatísticas foram feitas através dos Testes de Fisher, Spiro-Wilk, Correlação de Pearson, Spearman e os coeficientes da correlação foram utilizados para estimar a variação de variáveis dependentes, explicadas por variáveis independentes. Resultados: A variação do MIF total foi entre 79 e 110 e a relação entre a média da força ipsilateral dos músculos rotadores foi 0,94 em 75°/s e 0,95 em 150°/s para o lado direito e respectivamente 0,96 e 0,93 para o membro esquerdo. Usuários de cadeira de rodas apresentam desequilíbrio entre rotadores e as covariáveis de tempo de lesão e relação de pico de torque dos rotadores de ombro apresentam valor preditivo significativo no MIF total. Conclusão: Estes resultados sugerem uma correlação entre os pacientes estudados e comprometimento da articulação do ombro.
Résumé
Background: Type-2 Diabetes mellitus (T2DM) is a metabolic disease characterized by hyperglycemia and may causes long term organs dysfunctions like retinopathy, nephropathy, neuropathy, cardiovascular and autonomic dysfunction. Musculoskeletal and nervous system can also be affected by T2DM resulting pain, dysfunctions and disabilities. Objectives: This study is to find the prevalence of different pain conditions in patients with T2DM.Material & Methods:The study was conducted in public and private hospitals of four cities (Brahmanbaria, Dhaka, Gazipur and Faridpur) of Bangladesh from 1st April to 31st September, 2021. The patients of type II diabetes mellitus with both gender and age above 40 were included, and patients with other active systemic disease of bones and soft tissues were excluded. A self-structured questionnaire was developed. The questionnaire was distributed among 500 patients, out of whom 450 patients responded. The non-probability convenient sampling technique was used for data collection. The data was analyzed by SPSS and percentages were calculated to estimate the musculoskeletal complications in patients with T2DM.Results:The result showed high prevalence of pain conditions in T2DM patients. Older age groups of 61-65 (24%) years suffering from T2DM for more than 3 years having higher bloodsugar level 17-19 mmol/L with positive family history of DM were affected mostly. The prevalence of musculoskeletal pain condition in T2DM was 71.11%, while the low back pain was (42.88%), frozen shoulder was 31.33%, diabetic neuropathy was (26.89%) were the most common musculoskeletal problems, followed by knee pain (17.33%). Conclusions:It is concluded that the prevalence of different pain conditions are high among patients of T2DM and low back pain, shoulder pain, peripheral neuropathy and knee pain are common. These are mostly manageable conservatively.
Résumé
Background: The scapulothorasic joint plays an important role in overall shoulder function by providing a stable base for glenohumeral rotation. Snapping scapula syndrome, a likely under diagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is difficult to understand, sometimes mimic with shoulder pain. Dysfunctioning of any of muscles, ligament, bursa may cause abnormal scapular motion and predispose to scapulothoracic joint disorders. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or noninvesiveintervension treatment.Results:The causes of scapulothoracic bursitis and crepitus include direct or indirect trauma, overuse syndromes, glenohumeral joint dysfunction, boney abnormalities, muscle microtrauma or atrophy or fibrosis, and idiopathic causes. Scapulothoracic bursitis and crepitus remain primarily clinical diagnoses. However, imaging studies or local injections may also be helpful. The initial treatment of scapulothoracic bursitis and scapulothoracic crepitus should be conservative. Intevension procedure is best for treating modalitis for scapulothoracic dysfunction, most reports have demonstrated well to excellent outcomes in a significantly high percentage of patients.Conclusions:Clearly, the best initial approach to these conditions is a conservative treatment like nonsteroidal antiinflammatory drugs plan that combines scapular strengthening, postural reeducation, and core strength endurance. If an appropriate trial of nonoperative management proves unsuccessful, local non invesiveintervension can produce good results.