The major pain source of rotator cuff-related shoulder pain: A narrative review on current evidence.

BACKGROUND: Rotator cuff-related shoulder pain (RCRSP) was proposed to have a complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the updated research to analyse the traditional concept of shoulder impingement which may not be accurate. Current studies have demonstrated that mechanical factors including a reduction in subacromial space, scapular dyskinesia and different acromial shapes are unlikely directly contributing to RCRSP. AIMS: Since the precise RCRSP pain mechanism remains unclear, the aim of this narrative review is to discuss possible sources of pain contributing to RCRSP according to the mechanisms-based pain classifications. RESULTS AND DISCUSSION: Research findings on potential mechanical nociceptive factors of RCRSP are conflicting; investigations of neuropathic and central pain mechanisms of RCRSP are limited and inconclusive. Overall, available evidence has indicated moderate to strong correlations between RCRSP and chemical nociceptive sources of pain. CONCLUSION: Results from current research may provide new directions for future studies on the aetiology of RCRSP and its clinical management towards a biochemical view instead of the traditional mechanical hypothesis.

The Usefulness of Serological Inflammatory Markers in Patients with Rotator Cuff Disease-A Systematic Review.

Background and Objectives: Rotator cuff disease (RCD) is a prominent musculoskeletal pain condition that spans a variety of pathologies. The etiology and precise diagnostic criteria of this condition remain unclear. The current practice of investigating the biochemical status of RCD is by conducting biopsy studies but their invasiveness is a major limitation. Recent biochemical studies on RCD demonstrate the potential application of serological tests for evaluating the disease which may benefit future clinical applications and research. This systematic review is to summarize the results of available studies on serological biochemical investigations in patients with RCD. Methods: An electronic search on databases PubMed and Virtual Health Library was conducted from inception to 1 September 2021. The inclusion criteria were case-control, cross-sectional, and cohort studies with serological biochemical investigations on humans with RCD. Methodological quality was assessed using the Study Quality Assessment Tool for Observational Cohort and Cross-sectional studies from the National Heart, Lung, and Blood Institute. Results: A total of 6008 records were found in the databases; of these, 163 full-text studies were checked for inclusion and exclusion criteria. Nine eligible studies involving 984 subjects with RCD emerged from this systematic review. The quality of the studies found ranged from poor to moderate. In summarizing all the studies, several fatty acids, nonprotein nitrogen, interleukin-1 ß, interleukin-8, and vascular endothelial growth factor were found to be significantly higher in blood samples of patients with RCD than with control group patients, while Omega-3 Intex, vitamin B12, vitamin D, phosphorus, interleukin-10, and angiogenin were observed to be significantly lower. Conclusions: This is the first systematic review to summarize current serological studies in patients with RCD. Results of the studies reflect several systemic physiological changes in patients with RCD, which may prove helpful to better understand the complex pathology of RCD. In addition, the results also indicate the possibility of using serological tests in order to evaluate RCD; however, further longitudinal studies are required.

Teaching Physiotherapy Students Physical Examination Skills by Using Photogrammetry: A Randomized Control Trial of 3- Versus 2-Dimensional Images.

INTRODUCTION: Education research explains how healthcare professional training could be more efficient and effective by integrating simulation technology. Despite its relevance in training medical students, the evidence of its effectiveness in the manual skill training of physiotherapy students remains limited. The aim of this study was to compare the effectiveness of 3-dimensional (3D) images of real objects produced by photogrammetry and traditional 2-dimensional (2D) images when introducing manual therapy skills to undergraduate physiotherapy students via an online course. METHODS: In a randomized controlled trial, a group of first-year physiotherapy bachelor honor degree students participated in a 2-hour online course on 3 manual assessment skills: cervical compression, distraction, and flexion-rotation tests. They demonstrated 2 sets of learning materials, including either 3D images of real rotating objects using close-range photogrammetry (experimental group) or traditional 2D images (control group). After their respective training, an Objective Structured Clinical Evaluation procedure was conducted to demonstrate their knowledge about the techniques. A standardized 9-item practical performance test was used as the primary outcome measure for the analyses. RESULTS: Seventy-seven students participated in the study. The average Objective Structured Clinical Evaluation score for the experimental group (n = 40) was 41.3/50 (±3.9) and the control group (n = 37) was 39.1/50 (±4.5, P = 0.02). CONCLUSIONS: For learning 3 cervical spine assessment skills, this study shows that photogrammetry creates 3D images of real rotating objects that are more effective than 2D images for first-year physiotherapy students.

The Effectiveness of Spinal Manipulation in Increasing Muscle Strength in Healthy Individuals: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to systematically review the effects of spinal manipulation on muscular strength in healthy individuals and conduct a meta-analysis to appraise the quality of evidence. METHODS: Articles were searched and retrieved from MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, Academic Search Premier, SPORTDiscus, and AMED. Searches were conducted in September 2017 without a limit on the starting period. The Physiotherapy Evidence Database scale was used to appraise the quality of the included studies. Data from eligible articles were pooled, and meta-analyses were conducted. The quality of evidence was appraised by the Grading of Recommendations, Assessment, Development and Evaluations approach. The registration number for the review on PROSPERO is CRD42017075215. RESULTS: A total of 911 records were screened, and 3 randomized controlled trials were eligible to be included in this review. There was a significant pooled standardized mean difference in isometric strength (0.93, 95% confidence interval [CI], 0.17-1.68; P = .02) between the experimental and control groups, with a moderate level of heterogeneity. CONCLUSION: This review suggests that spinal manipulative therapy augments the percentage of change in isometric strength gain among healthy participants when compared to no intervention or sham manipulation. However, the heterogeneity of pooled studies in this review suggests that the results should be interpreted with caution.

A brief report on the clinical trial on neural mobilization exercise for joint pain in patients with rheumatoid arthritis.

BACKGROUND: In rheumatoid arthritis (RA) synovitis, activation of synoviocytes and infiltration of adaptive immune cells leads to synovial hyperplasia and joint swelling. Under the elevated extra-neural pressure, free nerve endings release neuropeptides, calcitonin gene-related peptide, and substance P, thus promoting neurogenic inflammation. OBJECTIVE: This study aimed to assess the effect of therapeutic neural mobilization (NM) exercises targeting the nervous system on disease impact in RA patients. METHODS: A total of 21 RA patients were randomized into NM (n = 11) and control (n = 10) groups. NM group patients performed NM exercises targeting the median, musculocutaneous, femoral, and saphenous nerve, as well as the entire nervous system twice daily for 4-8 weeks. Control RA patients performed gentle joint mobilization exercises targeting the same joints. Primary outcome was the change in pre-/post-treatment score in the validated Rheumatoid Arthritis Impact of Disease (RAID). Secondary outcome was erythrocyte sedimentation rate (ESR). RESULTS: There were no significant differences between the groups at baseline. No adverse events were observed and compliance was over 90%. Post-treatment, favorable changes were observed in the NM group RAID score: -5.1 vs. -0.8; weighted RAID score: -0.79 vs. -0.15. ESR was reduced in the NM group, albeit non-significantly. Regarding the RAID score domains, the NM group demonstrated significant improvements in pain and coping. CONCLUSION: The current data indicate a beneficial effect of NM exercises on pain and self-efficacy in our RA patients. Larger clinical studies are warranted to determine the clinical effectiveness of NM as a treatment for pain for RA patients and simultaneously address immune and neuropeptide modulation through NM.

Changes in Lower Limb Strength and Function Following Lumbar Spinal Mobilization.

OBJECTIVE: The purpose of this study was to investigate whether grade III passive lumbar rotational mobilization on L2-3 can improve hip flexor strength and performance in the single-leg triple-hop test in asymptomatic young adults. METHODS: Twenty-four participants (12 men, 12 women) aged from 19 to 26 years who were positive in the hip flexor "break" test were recruited in this study. They were randomly allocated to the treatment group or sham group. Isometric hip flexor torque (N·m) and single-leg triple-hop distance (cm) were measured before and after a passive lumbar rotational mobilization or a sham intervention. RESULTS: After the intervention, both the treatment and sham groups exhibited a significant increase in longest hop distance (P = .040 and .044, respectively). The treatment group had a significantly higher (3.41 ± 5.44%) positive percentage change in torque than the sham group (-2.36 ± 5.81%) (P = .02). CONCLUSION: The study results indicated a potential effect of grade III passive lumbar rotational mobilization in improving hip flexor strength. However, whether the improvement in hopping performance was the result of a treatment effect or a learning effect could not be determined.