It is unclear what baseline factors predict recovery from rotator cuff (RC) tendinopathy, making evidence-based prognostic estimates difficult. The study aimed to identify predictors of RC tendinopathy recovery to guide clinical decision-making.

People with RC tendinopathy were recruited to an international prospective cohort study. Participants completed a detailed baseline survey in which 41 plausible bio-psychosocial and demographic factors were measured. Recovery was established via the Global Rating of Change scale at monthly follow-ups for a year. Univariate and multivariate Cox proportional-hazards regression analyses were conducted to identify predictors and to build models. Model performance (internal validity) was evaluated using bootstrapping.

Seventy-three people with RC tendinopathy (43.9 ± 14.0 years; Shoulder Pain and Disability Index = 37.7 ± 24.4; 45 females) were recruited, providing 15,284 days at risk (208 ± 129 days). The recovery rate was 47%. Participants typically recovered around month seven. Being moderately active (hazard ratio (HR) = 2.23) and having higher health status (HR = 1.03) were associated with recovery. Demographic and shoulder severity variables did not improve the model performance nor individually predict recovery. The final model partially predicted recovery with near acceptable performance (optimism-corrected Harrell's C discrimination = 0.66 and Calibration Slope = 0.99).

The inadequate recovery rate in RC tendinopathy (under 50%) indicates a necessity for enhancements in treatment strategies for this condition. Demographic variables and shoulder pain severity are not useful factors to predict RC tendinopathy recovery. However, clinicians may consider assessing baseline health status and activity level to guide decision-making as these variables partially predict recovery. Strategies to include these factors in intervention development should be considered.

To determine whether psychosocial factors, such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in individuals with rotator cuff-related shoulder pain (RCRSP) following an education program.

One hundred forty-three individuals with persistent RCRSP were included in this prospective cohort study. At baseline, participants completed self-reported questionnaires related to pain, disability, and psychosocial constructs, including resilience, stress, catastrophizing, anxiety and depressive symptoms, pain self-efficacy, and social support. Thereafter, participants took part in an educational program aimed at promoting self-management of RCRSP that included 2 meetings with a physiotherapist. After 12 and 24 weeks, participants filled out pain and disability questionnaires and, based on their scores, were classified as having persistent shoulder pain or as recovered.

A univariable modified Poisson regression showed that higher perceived stress (RR adjusted : 1.02; 95% CI: 1.01-1.04), catastrophizing (RR adjusted : 1.01; 95% CI: 1.01-1.02), symptoms of depression (RR adjusted : 1.03; 95% CI: 1.01-1.06) and anxiety (RR adjusted : 1.03; 95% CI: 1.01-1.06), along with lower resilience (RR adjusted : 0.90; 95% CI: 0.81-1.00), were associated with ongoing RCRSP at 12 weeks. In addition, reduced pain self-efficacy was associated with persistent pain at both 12 weeks (RR adjusted : 0.98; 95% CI: 0.97-0.99) and 24 weeks (RR adjusted : 0.99; 95% CI: 0.98-1.00). Multivariable regression indicated that only pain self-efficacy served as a protective factor against persistent RCRSP (RR adjusted : 0.98; 95% CI: 0.97-0.99).

This study sheds light on the impact of psychosocial factors on persistent RCRSP, underscoring the importance of positive beliefs in pain management. Importantly, pain self-efficacy emerges as a key factor in recovery.

Humeral shaft fractures are routinely managed nonoperatively, but this approach is potentially associated with higher nonunion rates and inferior functional outcomes when compared with operative fixation.

To assess whether there is any difference in outcome between surgery and functional bracing for adults with an isolated, closed humeral shaft fracture.

This prospective, superiority, parallel-group randomized clinical trial was conducted between September 2018 and October 2023 and took place at an academic major trauma center in the United Kingdom. Patients were reviewed at 2 and 6 weeks and 3, 6, and 12 months postintervention. Patients included 70 adults with an isolated, closed humeral shaft fracture. Exclusion criteria included absolute indications for surgery, pathological/periprosthetic fractures, multiple traumas, significant frailty, and inability to comply with follow-up. Data were analyzed from November 2023 through January 2024.

Open reduction and plate fixation (n = 36) or functional bracing (n = 34). Seven patients did not receive their assigned treatment (operative, 5; nonoperative, 2).

The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand score (DASH) at 3 months postintervention. Secondary outcomes included health-related quality of life (EuroQol 5-Dimension [EQ-5D]/health visual analog scale [EQ-VAS] and Short Form [SF]-12 Physical Component Summary [PCS]/Mental Component Summary [MCS] scores), pain, shoulder/elbow range of motion, and complications. Intention-to-treat analyses were used.

The study included 70 patients (mean [SD] age, 49 [17.1] years; 38 female [54%] and 32 male [46%]). At 3 months, 66 patients (94%) had completed follow-up. The operative group had a significantly better DASH score (difference, 15.0; P = .01). Surgery was also associated with a superior DASH score at 6 weeks (difference, 14.7; P = .01), but not at 6 months (P = .10) or at 12 months (P = .78). Surgery was further associated with a higher EQ-5D score (6 weeks: difference, 0.126, P = .03), EQ-VAS score (6 months: difference, 7; P = .04), and SF-12 MCS score (6 weeks: difference, 9.3; P = .001; 3 months: difference, 6.9; P = .01; and 6 months: difference, 7.1; P = .01). Brace-related dermatitis was significantly more common in the nonoperative group (18% vs operative 3%; P = .05). There were 8 nonunions (11%; operative 6% vs nonoperative 18%, P = .14).

For patients with a humeral shaft fracture in this study, surgery conferred early functional advantages over bracing. However, these benefits should be considered in the context of potential operative risks and the absence of any difference in outcomes at 1 year.

ClinicalTrials.gov Identifier: NCT03689335.

Shoulder pain is a debilitating musculoskeletal condition with functional, physical, and psychological impacts. Interventions for chronic shoulder pain should address the biopsychosocial model, with Cognitive Functional Therapy (CFT) emerging as a promising physiotherapy approach. CFT approaches the multidimensional nature of pain, integrating physical and cognitive aspects. To date, no study has assessed the effectiveness of CFT in individuals with chronic shoulder pain. Therefore, this randomized controlled trial aims to compare the effects of CFT to therapeutic exercises on pain intensity, disability, self-efficacy, sleep quality, biopsychosocial aspects, and central pain processing in individuals with chronic shoulder pain.

This will be a randomized controlled trial, single-blinded with two parallel groups. Seventy-two individuals with chronic shoulder pain will be randomly assigned to one of two groups: CFT or Therapeutic exercise. The interventions will last 8 weeks, with the CFT group receiving therapy once a week and the therapeutic exercise group receiving sessions twice a week. The primary outcomes will be pain intensity and disability, while the secondary outcomes will include function, self-efficacy, sleep quality, biopsychosocial factors, perception of improvement/deterioration, and central pain processing. The outcome measures will be assessed at baseline, 4th week, end of treatment (8th week), and 12th-week follow-up.

The results of this study will contribute to understanding the effectiveness of CFT in treating individuals with chronic shoulder pain. Trial registration number: NCT06542666.

To fully comprehend shoulder pain and disability, a better understanding of the factors that may contribute to chronicity is required, i.e., increased central sensitivity.

To determine the association between increased central sensitivity and shoulder disability whilst accounting for confounding factors. To determine the prevalence of increased central sensitivity in those with musculoskeletal shoulder symptoms.

Cross sectional design collecting data via an online survey. Participants with shoulder symptoms were recruited via social media and through flyer advertisement in Australia.

The Central Sensitivity Inventory and Shoulder Pain and Disability Index were used. Confounding factors included sex, age, socioeconomic status, obesity, psychological distress, sleep quality, physical activity, smoking, ethnicity, and the symptoms of neuropathic pain. The association between increased central sensitivity and shoulder disability was assessed by linear regression whilst adjusting for confounding factors. The percentage of participants with increased central sensitivity was calculated.

In 249 participants with shoulder symptoms, increased central sensitivity was positively associated with greater shoulder disability, either as a categorical (coefficient 5.5, 95 % CI 0.1-11.0, p 0.046) or continuous variable (coefficient 0.2, 95 % CI 0.03-0.50, p 0.025) whilst adjusting for confounding factors. In the sample, 48.2 % of survey respondents met the threshold for having increased central sensitivity.

Increased central sensitivity was positively associated with greater disability even when accounting for multiple confounders in participants with musculoskeletal shoulder symptoms. These findings highlight the importance of considering increased central sensitivity in the clinical management of those with shoulder symptoms.

Muscle energy techniques (MET) for shoulder muscles improve both shoulder muscle tension and the range of motion of the glenohumeral joint. This systematic literature review will investigate the effects of MET on shoulder pain as a result of muscle tension in the glenohumeral joints of patients with shoulder disorders and collect clinical evidence regarding the effectiveness of muscle energy techniques on glenohumeral joint pain. Based on previous studies, we anticipate that MET may significantly affect shoulder joint pain. We expect to provide moderate to high levels of evidence regarding the effectiveness of MET in the treatment of shoulder pain.

Nine electronic databases will be searched for articles published up to November 2024, including PubMed, EMBASE, CENTRAL, KCI, KISS, KMbase, RISS, DBpia, and OASIS. Search terms will consist of terms related to the outcome (e.g., "shoulder") and intervention (e.g., "muscle energy technique," "post-isometric relaxation," "isometric stretching"). Studies selected for the systematic review and meta-analysis will include randomized controlled clinical trials and studies using MET applied to the human shoulder muscles. Qualitative and case studies will be excluded. Two authors will independently assess each study for eligibility and risk of bias and extract the data. This study will analyze the effects of MET on shoulder pain. Additionally, we intend to demonstrate the effect size of muscle energy techniques on factors such as range of motion. Our study will provide clinical evidence for the effects of muscle energy techniques on shoulder joint pain. Our study aims to provide clinical evidence supporting the moderate-to-high effectiveness of MET in treating shoulder joint pain.

ClinicalTrials.gov CRD42024532367.

The aim of the study was to investigate the effects of vibration therapy to home-based exercises on shoulder muscle strength, range of motion, pain-related disability, and muscles viscoelastic properties of shoulder and neck in patients with breast cancer undergoing radiotherapy.

This randomized controlled superiority trial was conducted with 38 participants who underwent breast cancer surgery. All patients were randomized into two groups: control group and vibration group. Both groups performed home-based exercises for 5 days a week for 6 wks. Vibration group received additional vibration therapy for 2 days a week for 6 wks. Shoulder range of motion, muscle strength, pain, disability, grip strength, and viscoelastic properties of the pectoralis major, upper trapezius, and sternocleidomastoid were compared before and after intervention.

Vibration group demonstrated better improvement in shoulder range of motion, muscle strength, and pain-related disability ( P < 0.05), except for internal rotation range of motion. Only tone of pectoralis major was significantly higher in vibration group according to group x time interaction ( P < 0.05), no differences were detected in terms of muscle viscoelastic properties in the control group patients ( P > 0.05).

Vibration therapy provided superior improvements in muscle strength, range of motion, and pain-related disability compared to home-based exercises alone in patients with breast cancer undergoing radiotherapy in the early postoperative phase.

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

Upon completion of this article, the reader should be able to: (1) Determine the impact that whiplash-associated disorders have on a patient's life; (2) Identify and recognize the greater benefits of a supervised exercise therapy on recovery after a whiplash injury; and (3) Differentiate between the different exercise protocols conducted (types of exercises and duration) and incorporate therapy appropriately as part of an effective treatment plan.

Advanced.

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Despite the availability of numerous treatment modalities for frozen shoulder, spanning from nonsurgical approaches to surgical interventions, a consensus regarding the most effective treatment remains elusive. Current studies emphasize that pain in frozen shoulder affects central nervous system activity and leads to changes in cortical structures, which are responsible for processing sensory information (like pain) and controlling motor functions (like movement). These cortical changes highlight the importance of including the central nervous system in the management of frozen shoulder. It is therefore recommended that treatment should provide more effective management by focusing not only on the shoulder region but also on the cortical areas thought to be affected.

Among patients treated nonsurgically for frozen shoulder, is graded motor imagery added to a multimodal physical therapy program more effective than multimodal physical therapy alone in terms of (1) Shoulder Pain and Disability Index (SPADI) scores, (2) pain with activities and QuickDASH (Q-DASH) scores, and (3) ROM after 8 weeks of treatment?

In this randomized clinical trial, we considered the following as eligible for inclusion: (1) ROM < 50% compared with the unaffected shoulder, (2) clinically and radiologically confirmed primary frozen shoulder, and (3) 30% loss of joint ROM in at least two planes compared with the unaffected shoulder. Diagnosis of patients was based on patient history, symptoms, clinical examination, and exclusion of other conditions. A total of 38 patients with frozen shoulder were randomly assigned to either the graded motor imagery group (n = 19) or the multimodal physiotherapy group (n = 19). The groups did not differ in age, height, weight, gender, and dominant and affected side. In both groups, there were no losses to follow-up during the study period, and there was no crossover between groups. The multimodal physiotherapy program encompassed a variety of treatments, including stretching exercises, ROM exercises, joint-oriented mobilization techniques, scapular mobilization, strengthening exercises, and the application of cold agents. The graded motor imagery program, as an addition to the multimodal physiotherapy program, included the following steps: (1) left-right discrimination (identifying left and right body parts), (2) motor imagery (mentally visualizing movements), and (3) mirror therapy training (using mirrors to trick the brain into thinking the affected part is moving). Both groups of patients participated in a program of 12 sessions, each lasting approximately 45 minutes, twice a week for 6 weeks. Participants were assessed at baseline, after 6 weeks, and at 8 weeks. The primary outcome was the SPADI score, which ranges from 0 to 100, with higher values denoting greater disability. The minimum clinically important difference (MCID) for SPADI scores is reported to be 13.2 points. Secondary outcomes were shoulder ROM, Numeric Pain Rating Scale activity score (scored from 0 points, indicating "no pain," to 10 points, indicating "worst pain imaginable"), and Q-DASH score (ranging from 0 to 100 points, with a higher score indicating higher functional disability). Repeated-measures analysis of variance was used to compare means between one or more variables based on repeated observations.

After 8 weeks of treatment, patients treated with graded motor imagery plus multimodal physical therapy experienced greater mean ± SD improvement from baseline in terms of SPADI scores than did the multimodal physical therapy group (65 ± 9 versus 55 ± 12, mean difference 10 points [95% confidence interval 4 to 17 points]; p = 0.01). Graded motor imagery when added to standard therapy did not produce a clinically important difference in pain scores with activity compared with physical therapy alone (7.0 ± 1.3 versus 5.9 ± 1.4, mean difference 1 point [95% CI 0.2 to 2.0 points], which was below our prespecified MCID; p = 0.04). However, improvements in Q-DASH score at 8 weeks were superior in the graded motor imagery group by a clinically important margin (58 ± 6 versus 50 ± 10, mean difference 9 points [95% CI 3 to 14 points], which was below our prespecified MCID; p = 0.01). ROM was generally better in the group that received the program augmented by graded motor imagery, but the differences were generally small.

Adding graded motor imagery to a multimodal physiotherapy program was clinically superior to multimodal physiotherapy alone in improving function in patients with frozen shoulder. However, no clinically superior scores were achieved in ROM or activity-related pain. Additionally, the follow-up period was short, considering the tendency of frozen shoulder to recur. Although adding graded motor imagery provides superiority in many scores and does not require high-budget equipment, the disadvantages such as the difference in some scores being sub-MCID and the need for expertise and experience should not be ignored. Consequently, while graded motor imagery shows promise, further research with longer follow-up periods is recommended to fully understand its benefits and limitations in the treatment of frozen shoulder.

Level I, therapeutic study.

This study aimed to determine the clinical efficacy of Kinesiotaping (KT) combined with a rehabilitation program to reduce symptoms and functional limitations in patients with Rotator Cuff-Related Shoulder Pain (RCRSP) in Vietnam.

In total, 82 participants who were diagnosed with RCRSP were randomly allocated into two groups. Both groups received a standard rehabilitation program; additionally, the intervention group was treated with KT. Outcomes, assessed at baseline, and 3, 7, and 14 days postintervention, included pain intensity (Visual Analogue Scale, VAS), functional disability (Shoulder Pain and Disability Index, SPADI), and active range of motion (ROM).

The KT group exhibited significant improvements in all outcome measures. VAS scores decreased by an average of 13.3 points in the KT group at 14 days, which was notably greater than that in the control group (95% CI: -17.77 to -8.82). SPADI scores also improved significantly in the KT group, with reductions of -11.36, -15.27, and -13.3 at days 3, 7, and 14, respectively. Regarding ROM, the KT group showed notable improvements in flexion and external rotation, with flexion ROM differences of 10.78, 10.35, and 11.8 degrees at the respective time points. No significant changes were observed in the abduction or internal rotation ROM. After adjusting for age, baseline scores, and gender, there was a statistically significant interaction between Group and Time on the VAS, SPADI, and ROM abduction.

Incorporating KT into a standard rehabilitation program for RCRSP demonstrated enhanced efficacy in reducing pain and improving shoulder function. The results suggest that KT can be a valuable component of the treatment regimen for RCRSP.

BackgroundThe Shoulder Pain and Disability Index (SPADI) is one of the most widely used Patient Reported Outcome Measures designed to assess the severity of pain and disability in patients with shoulder conditions.ObjectiveThe aim of the study is to define the clinically significant outcomes of the Minimum Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) for the SPADI scores after Rotator Cuff Repair (RCR).MethodsThe present study takes into account patients undergone RCR with a 6-month follow-up. The MCID, PASS and SCB of the SPADI score were evaluated using both distribution and anchor approaches.ResultsFifty-nine patients (mean aged 60.3 ± 13.1 years) who had undergone RCR in a single surgical center were retrospectively included. The MCID cutoff of the SPADI total score after RCR from the initial evaluation to 6 months post-operatively was 17 (95% CI:13.6,20.4). The outcome measures for the MCID and SCB values of the SPADI pain score were 26 (95% CI:22.3,29.7) and 37 (95% CI:33.4,40.6), respectively. The MCID threshold of the SPADI disability score was 21.9 (95% CI:18.7,25.1). A value of at least 76.9 (95% CI:73.4,80.4), 75 (95% CI:71.6,78.4), and 78.1 (95% CI:74.6,81.6) for SPADI total, pain, and disability dimensions, represented the PASS.ConclusionsThe study shows significant improvements in SPADI scores after RCR, suggesting that could lead to meaningful pain relief and functional recovery. The findings indicate that a post-operative SPADI total score of at least 76.9 correlates with patient satisfaction regarding shoulder health.

This study aims to evaluate the pain and clinical evolution of patients with shoulder pain with cooled radiofrequency ablation (CRFA).

A cohort prospective study of patients with shoulder pain for >3 months. All patients included were treated with CRFA in the sensitive innervation around the shoulder (lateral pectoral, suprascapular nerve, axillary nerve), and were followed for 24 weeks. Pain was evaluated with the visual analog scale, while clinical evolution was evaluated with several scales of shoulder function.

Fifteen patients were included. All patients improved significantly the pain during the time of the study. The clinical function of the shoulder shows a significant improvement during the 24 weeks of follow-up.

CRFA is a medical procedure that helps to improve pain and function related to shoulder pain independently of the primary pathology in the shoulder.

The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR.

We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR.

Randomized controlled single-blind study.

Level 1B.

A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized "DM-Co-A Training" was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality.

There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group (P < 0.05).

A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.

Patient-reported outcome measures are a valuable tool to evaluate an intervention from a patient's perspective. Previous evidence shows that, while resident involvement may increase operative times, it does not affect complications or patient-reported outcomes. This study sought to assess the impact of a new residency program on patient-reported outcome measures, operative time, and complication rates in total shoulder arthroplasty.

A retrospective cohort study was performed of patients who underwent total shoulder arthroplasty at a single health care system. Demographic data, resident presence during shoulder arthroplasty, arthroplasty type, procedure duration, complications, and American Shoulder and Elbow Surgeons (ASES) score change were collected. Patients 18 years or older who underwent primary anatomic or reverse total shoulder arthroplasty were included. Patients who did not meet the inclusion criteria, had a preoperative diagnosis other than primary osteoarthritis, lacked preoperative and postoperative ASES scores, and canceled procedures were excluded.

A total of 139 patients were identified and included in our analysis. Ninety-seven total shoulder arthroplasties were performed with a resident not present, and 42 with a resident present. This study showed no significant effects of the presence or absence of a resident on ASES scores, complication rates, or surgery times.

This study adds to previous evidence indicating that attending orthopedic surgeons can support resident learning and surgical skill development while maintaining patient-reported outcome measures, surgical time, and complication rates similar to those without resident involvement when performing shoulder arthroplasty. [Orthopedics. 2025;48(2):104-110.].

This study aimed to investigate the correlation between mental and physical health-related quality of life and the outcomes of conservative treatment in patients with frozen shoulder (FS).

This was a two-center retrospective study. It included 84 consecutive patients who underwent a 3-month treatment comprising education, physical therapy, and corticosteroid-anesthetic injections. Changes in range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) scores, measured at baseline and after 3 months, were selected as dependent variables. Data on age, sex, Body Mass Index, duration of symptoms, dominant affected limb, and Short Form-36 (SF-36) subscales were gathered at baseline and investigated as prognostic factors. Backward stepwise regression models were used to identify significant associations.

At 3-month follow-up, all the patients showed significant improvement. Higher SF-36 General Health, Mental Health and Social Functioning scores at baseline were associated with a greater beneficial change in ROM and SPADI. In contrast, lower SF-36 Bodily Pain and Role Emotional scores were found to be associated with greater improvement.

The study findings indicate that the self-perceived mental and physical health of patients have a significant impact on both subjective and objective clinical outcomes and healthcare professionals should take these aspects into account.

Prognostic Level II.

Background: Mulligan's mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.

The objective of this cross-sectional study was to compare the physical activity level between individuals with and without rotator cuff related shoulder pain (RCRSP), and, in individuals with RCRSP, investigate whether biopsychosocial factors are associated with the physical activity level.

Seventy-four participants with and 84 participants without RCRSP wore a fitness tracking watch for seven consecutive days to assess physical activity (step count, moderate-to-vigorous physical activity (MVPA)-minutes). Additionally, participants with RCRSP completed questionnaires on their level of pain, disability, and physical activity (short version of the International Physical Activity Questionnaire [IPAQ]), as well as on biopsychosocial factors, including resilience, stress, catastrophizing, anxiety and depressive symptoms, self-efficacy, and social support. Statistical analysis included Mann-Whitney U tests and General Linear Models for group comparisons, as well as multiple regression analyses to explore predictors of physical activity.

No significant between-group difference was found concerning step count and MVPA-minutes. Age and depressive symptoms explained 14% of the variance in step count, while age and resilience explained 15% of MVPA-minutes variance. Additionally, resilience was associated with IPAQ (P < 0.05), indicating that higher resilience correlates with greater reported physical activity (odds ratio: 2.32 [1.27, 4.22]).

While individuals with RCRSP did not show lower physical activity levels compared to their healthy counterparts, greater physical activity was associated with younger age, lower depressive symptoms, and higher resilience in individuals with RCRSP. Future research should explore whether resilience and physical activity interventions can prevent the transition to persistent RCRSP.

Adequate treatment of proximal humeral fractures (PHF) is essential for restoring shoulder function and expediting return-to-work (RTW). This study aims to assess the impact of conservative and operative treatments on RTW and PHF recovery.

In a retrospective case-control study, 858 patients (aged 18-68) treated for PHF between 2018 and 2021 were included. Questionnaires were sent to 342 operatively treated patients (Operative group (OG)) and 191 conservatively treated matched controls (Conservative group (CG)). Assessments covered RTW, functional outcomes (DASH, ASES), and quality of life (EQ-5D). A Kaplan-Meier analysis explored RTW in weeks.

With a 61% response rate, 73 eligible participants (40 OG, 33 CG) contributed. Of respondents, 67.1% were female, and 60% were employed pre-trauma. Almost 70% of employed patients RTW, with no significant difference between groups (log rank, p=0.36). Among those returning to work, OG tended to resume 4 weeks later than CG (OG 10.5, IQR 22 vs. CG 6.00, IQR 8 weeks, p=0.07). DASH, ASES, and quality of life VAS scores showed no statistical difference between groups (p=0.542, p=0.257, p=0.530, respectively).

The RTW proportion did not differ between operatively and conservatively treated PHF patients, though the former tended to return 4 weeks later. Functional outcomes demonstrated no significant differences. Further adequately powered studies are necessary to establish a standardized aftercare protocol for PHF, enhancing patient care and minimizing work disability.

The Shoulder Pain and Disability Index (SPADI) is a widely used 13-item shoulder-specific patient-reported outcome measure for shoulder pain disorders. The English version of SPADI is easy to use and demonstrates excellent measurement properties for clinical and research settings.

To translate and culturally adapt an Indonesian version of SPADI (SPADI-IDN) and then validate its use in Indonesian patients.

Cohort study (Diagnosis); Level of evidence, 2.

Through a forward and a backward translation process, the validity of the questionnaire was investigated. The study population was 100 patients with shoulder pain who were treated in a hospital in Indonesia. The patients were asked to fill out the SPADI-IDN during their visit. To evaluate the validity of SPADI-IDN, the patients were also asked to fill out the Medical Outcomes Study 12-Item Short-Form Health Survey and the Oxford Shoulder Score. To assess the test-retest reliability, the same patients were asked to fill out the SPADI-IDN questionnaire again 1 week later. The assessment of construct validity, test-retest reliability, internal consistency, floor and ceiling effect, and measurement of error followed the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) guidelines. The Bland-Altman method was used to explore absolute agreement.

Of the 100 eligible patients, all were used to assess construct validity, and 87 patients (87%) were used to assess test-retest reliability. Almost every established hypothesis about the correlations between SPADI-IDN and other questionnaires could be confirmed, implying good construct validity. No floor or ceiling effects were found. The intraclass correlation value was 0.99, indicating strong test-retest reliability. A Cronbach α was 0.95, indicating a good internal consistency. The Bland-Altman analysis did not reveal any bias. The standard error of measurement and the minimal detectable change at the individual and group levels were 2.65, 7.3, and 0.7, respectively.

The SPADI-IDN represents a valid and reliable tool for measuring pain and disability in patients with shoulder pain disorders.

The aim of this systematic review and meta-analysis is to assess the efficacy of mirror neuron system-based therapy for managing pain and improving motor and upper limb function in patients with upper limb orthopedic conditions.

Systematic bibliographical searches of the PubMed, SCOPUS, and CENTRAL registries and databases up to September 2023 were conducted to find randomized controlled trials (RCTs) assessing the efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions.

Two reviewers assessed the RCTs using a Cochrane risk-of-bias tool and extracted data from studies with similar outcome measures in the domains of pain, motor function, or functional score, which were pooled into meta-analyses.

The review included 13 studies to compare the efficacy of mirror neuron system-based therapy with that of conventional rehabilitation programs. The therapy reduced pain intensity (mean difference [MD] 2.04, 95% confidence interval [CI] 1.46-2.63) and kinesiophobia (MD 8.43, 95% CI 6.98 to 9.88), and increased grip strength (MD 1.86, 95% CI 0.28-3.45). The therapy also improved upper limb functional outcomes as assessed by the 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score (MD 13.52, 95% CI 10.63-16.41). However, the outcomes as assessed by the 11-item QuickDASH questionnaire and the Shoulder Pain and Disability Index (SPADI) were not superior to conventional rehabilitation.

Mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions may reduce pain intensity and kinesophobia, and improve grip strength and DASH scores compared with conventional rehabilitation programs. However, this interpretation is limited by the heterogeneity and various quality of the RCTs included in our meta-analysis.

To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Italian and study its classic psychometric properties in subjects with shoulder pain (SP).

The PSFS was translated into Italian and administered to 109 SP subjects. Acceptability (time to administer, floor and ceiling effects), reliability (internal consistency [Cronbach's alpha], test-retest reliability [Intraclass Correlation Coefficient (ICC)], and measurement error [Standard Error of Measurement (SEM), Minimal Detectable Change, (MDC)]), were assessed. Moreover, construct validity was investigated through a-priori hypothesis testing, comparing the PSFS with the Disability of the Shoulder, Arm and Hand (DASH) scale, 36-item Short Form Health Survey (SF-36) and Numeric Pain Rating scale (NPRS).

The PSFS was successfully adapted into Italian, and its acceptability was satisfied. Internal consistency was high (Cronbach's alpha = 0.925), and test-retest reliability was good (ICC = 0.866, 95% CI = 0.749-0.931). A SEM of 0.7 points and an MDC of 1.9 points were obtained. We observed moderate evidence for construct validity, with 4/6 correlations between other measures being respected.

This study provided reliability and validity of the PSFS in a sample of Italian SP subjects. Future studies should assess the responsiveness of using the PSFS as an outcome measure to capture clinical changes after treatment.

Pectoralis minor (PM) shortening and posterior shoulder tightness (PST) are considered potential soft tissue alterations associated with rotator cuff related shoulder pain (RCRSP). Yet, their precise contribution to pain and disability remains unclear.

To explore the association between both PM length and PST and self-reported shoulder pain and disability in individuals with and without RCRSP. Demographic characteristics and shoulder active range of motion (AROM) were also considered for their potential contributions to RCRSP.

This was a cross-sectional study.

Using Shoulder Pain and Disability Index (SPADI), 144 individuals were grouped by pain and disability severity: SPADI total score ≤20 and SPADI total score >20. PM length was measured using a tape measure. PST, glenohumeral joint flexion, internal (IR) and external (ER) rotation AROM were quantified using an inclinometer. Demographic and AROM measurements were compared between groups and regression analyses identified SPADI predictors.

Age, PST, glenohumeral flexion, and ER AROM were associated with SPADI total score (p < 0.05). Higher age (odds ratio (OR [95%CI]): 1.07 [1.02-1.12]) and increased PST (OR: 1.16 [1.04-1.29]) were associated with higher self-reported shoulder pain and disability scores (SPADI score >20). In contrast, increased flexion (OR: 0.93 [0.88-0.97]) and ER AROM (OR: 0.96 [0.93-0.99]) served as protective factors against increased levels of self-reported shoulder pain and disability. No other variables were associated with SPADI (p > 0.05).

PST is associated with increased levels of self-reported shoulder pain and disability, as are age, while PM length and IR AROM were not significantly associated variables. Glenohumeral flexion and ER AROM prevented increased levels of self-reported shoulder pain and disability.

Frozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder.

The study protocol was registered with PROSPERO (CRD42023475851). We searched the MEDLINE, Embase, and Cochrane Library databases in November 2023. Randomized controlled trials (RCTs) comparing SSNB against other interventions were included. The primary outcome was any functional patient-reported outcome measure. Secondary outcomes were the visual analogue scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk of bias v. 2.0 tool.

A total of 12 RCTs were identified (702 patients; mean age 55 years (30 to 72)). Eight RCTs were deemed "low" risk-of-bias and four raised "some concerns". Comparator interventions included intra-articular steroid injection (IAI), hydrodistension, physiotherapy, and placebo injection with 0.9% saline. Seven studies compared SSNB to IAI, with SSNB resulting in greater improvement in the Shoulder and Pain Disability Index (mean difference -4.75 (95% CI -8.11 to -1.39); p = 0.006) and external rotation (mean difference 11.64 (95% CI -0.05 to 23.33); p = 0.050). In three studies, SSNB demonstrated better VAS (mean difference -0.31 (95% CI -0.53 to 1.79); p = 0.004) compared to physiotherapy (with or without placebo injection). One study favoured hydrodistension over SSNB in improving ROM and VAS. There was no significant difference in outcomes between SSNB administered under ultrasound guidance or using a landmark technique.

SSNB can be administered in the outpatient clinic with promising outcomes compared to IAI or physiotherapy based on level I evidence. It can therefore be considered as a first-line treatment option.

Adhesive capsulitis is a distressing ailment that progressively limits the active and passive mobility of the shoulder joint. Physical therapy (PT) combined with intra-articular steroid (IAS) injection and suprascapular nerve block (SSNB) has shown improved functional outcomes. We aimed to assess whether providing both IAS injection and SSNB improved outcomes compared with IAS injection alone.

Ninety-six patients with adhesive capsulitis were randomized into three groups consisting of group IAS, group IAS+SSNB and group PT (control). All patients were assessed on day 0, week 2, 6 and 12 postintervention. The primary outcome was an improvement in Shoulder Pain and Disability Index (SPADI) scores at week 12 postintervention. Secondary outcomes were Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, Constant-Murley Range of Motion (ROM) scores, Quality of life (QoL) and Medication Quantification Scale (MQS) 3.

On combining IAS and SSNB, we found a statistically significant improvement in SPADI scores over IAS only at week 2 postintervention (33.6±8.0 vs 38.3±8.9, p=0.04) but not beyond. A significant reduction in SPADI, VAS and QuickDASH scores, along with an improvement in Constant-Murley ROM scores, was observed on day 0 and at weeks 2, 6 and 12 in both group IAS and group IAS+SSNB (p<0.05). MQS 3 scores significantly decreased up to week 6 in both groups. However, the addition of SSNB to IAS did not demonstrate a clinically significant difference in the study outcomes, except for a notable decrease in VAS in the immediate postintervention period. Additionally, no significant changes in QoL were observed among the groups (p>0.05).

Both IAS and IAS+SSNB improved analgesia, reduced disability and enhanced ROM. However, adding SSNB to IAS did not yield a clinically meaningful benefit in the study outcomes.Trial registration number TRIAL REGISTRATION NUMBER: CTRI/2022/08/044519.

Restriction of shoulder movements in frozen shoulder may negatively affect individual's daily living activities. The effect of the virtual reality (VR)-based exercise program, which is an innovative application and has been used in the field of physiotherapy in recent years, is unknown on patients diagnosed with frozen shoulder.

This study was conducted to determine the effects of a VR-based exercise program provided to patients with frozen shoulder on their pain, joint motion, and quality of life.

In the randomized controlled study, patients were divided into two groups to receive treatment five times a week for four weeks:VR-based exercise (VR group, n = 18) and conventional treatment(control group, n = 18). The data were collected using the VisualAnalog Scale, the Shoulder Pain and Disability Index, and the ShortForm - 36 health Scale.

In comparison to the pre-treatment measurements, improvements were observed in pain, joint range of motion, and quality of life in both groups after the treatment (p < .001). The improvement in pain observed in the VR group after the treatment was greater than that observed in the control group (U=-2.064, p= .030). After the treatment, the quality of life in the mental health dimension was better for patients in the VR group (U= -1.979, p= .048).

VR-based exercise was an effective method for reducing the pain levels and improving the mental health of patients diagnosed with frozen shoulder.

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its abbreviated version, QuickDASH, are commonly used patient-reported outcome measures (PROMs) for the assessment of an upper-extremity disability. Theoretically, they can be used to compare the treatment outcomes of different upper-extremity conditions. Despite increasingly widespread use for some shoulder conditions, these questionnaires have not been rigorously validated for use to assess the outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA). The objective of this study was to validate the DASH and QuickDASH scores for a longitudinal outcome assessment of patients undergoing aTSA to treat advanced glenohumeral osteoarthritis (GHOA).

In this study, 450 patients with a median age of 70.3 years (interquartile range [IQR] width, 11.7 years) were included; 52.4% of the patients were female. The DASH and QuickDASH questionnaires, the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and the EuroQol-5 Dimensions (EQ-5D) questionnaire were completed preoperatively and at follow-ups of 3 months, 6 to 12 months, and a minimum of 2 years by patients undergoing aTSA. The criterion validity, construct validity, reliability, and responsiveness of the DASH and QuickDASH were assessed.

The DASH and QuickDASH scores demonstrated moderate to very strong correlations with the ASES scores (ρ = -0.83 to -0.62), SST scores (ρ = -0.73 to -0.55), and EQ-5D scores (ρ = -0.72 to -0.57); minimal floor or ceiling effects; internal consistency (Cronbach alpha > 0.80); and large Cohen d and standardized response means (<1.6) at all time points. Very strong positive correlations were observed between the DASH and QuickDASH scores at all time points (ρ = 0.96 to 0.97).

The DASH and QuickDASH scores, which are region-specific rather than shoulder-specific, are valid, reliable, and responsive PROMs for the evaluation of patients with advanced GHOA treated with aTSA. Therefore, the DASH and QuickDASH scores can be used to compare the outcomes of aTSA for the treatment of advanced GHOA with the outcomes of treatment of other upper-extremity disorders, potentially facilitating comparative cost-effectiveness and value analysis studies.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Long head of biceps brachii tendinopathy, a frequent source of anterior shoulder pain, may lead to discomfort and diminished function. The objective of this study is to assess the efficacy of dry needling and transcutaneous electrical nerve stimulation in these patients.

Thirty patients were randomized into dry needling and transcutaneous electrical nerve stimulation groups and assessed before treatment, 8 and 15 days after treatment using a visual analogue scale, shoulder pain and disability index, pressure pain threshold, tissue hardness, and biceps peritendinous effusion.

Both treatments significantly reduced the visual analogue scale in immediate (p < 0.001), short-term (p < 0.01), and medium-term effects (p < 0.01). Dry needling outperformed transcutaneous electrical nerve stimulation for the pain (p < 0.01) and disability (p < 0.03) subscales of the shoulder pain and disability index in the short-term and medium-term effects, respectively. Pressure pain threshold increased after both treatments but didn't last beyond 8 days. Neither treatment showed any improvements in tissue hardness of the long head of biceps brachii muscle. Notably, only the dry needling group significantly reduced biceps peritendinous effusion in both short-term and medium-term effects (p < 0.01).

Dry needling showed non-inferior results to transcutaneous electrical nerve stimulation in reducing pain and disability and demonstrated even superior results in reducing biceps peritendinous effusion (see Graphical Abstract).

The Institutional Review Board of the China Medical University Hospital (CMUH107-REC2-101) approved this study, and it was registered with Identifier NCT03639454 on ClinicalTrials.gov.

To compare the effectiveness of intratissue percutaneous microelectrolysis (IPM) in addition to shoulder exercise program on pain intensity and disability in individuals with rotator cuff tendinopathy.

Two parallel arms, single-blind superiority randomized controlled trial. SITE: Outpatient clinic (Alcides Carneiro University Hospital).

Forty-two individuals with rotator cuff tendinopathy were randomly allocated (1:1) into 2 groups: IPM associated with exercises (IPM+Ex) and exercises only (Ex).

Both groups underwent a therapeutic exercise program (6 in-person sessions) conducted by a physiotherapist, but only the IPM+Ex group received additional treatment with IPM (6 sessions). Linear mixed models were used to compare groups.

Pain intensity was measured with the Numerical Pain Rating Scale and shoulder disability with the Shoulder Pain and Disability Index. The outcomes were evaluated (blinded assessor) at baseline and 8 weeks after the intervention protocol. The secondary outcomes included adverse effects, frequency of the weekly home exercises, and overall perceived effect.

Forty individuals completed the 8-week follow-up. There were statistically significant within-group changes in both IPM+Ex and Ex for pain (IPM+Ex: mean difference -3.19; 95% CI: -4.45 to -1.94; Ex: mean difference: -3.99; 95% CI: -5.27 to -2.72) and disability (IPM+Ex: mean difference -35.76; 95% CI: -47.77 to -23.76; Ex: mean difference: -38.26; 95% CI: -50.45 to -26.07). We found no between-group significant differences in either pain (mean difference: -1.23; 95% CI: -2.54, 0.07) or disability (mean difference 7.17; 95% CI: -7.02, 21.35). We found no differences between the groups (P<.05) regarding adverse effects, frequency of the weekly home exercises, and overall perceived effect.

Applying IPM along with therapeutic exercises does not have additional effects on pain intensity and disability in individuals with rotator cuff tendinopathy.

To evaluate the data on the psychometric properties of the Neck Disability Index (NDI).

Medline, Embase, PsychINFO, Web of Science, and Scopus were searched in April 2023. The random effects meta-analysis was conducted when possible.

Of 492 identified records, 79 were included. 70 studies were considered to be of low risk of systematic bias. Alpha was >0.81. Pooled test-retest intraclass correlation coefficient was 0.91 (95% CI 0.90-0.93). The NDI correlations with pain rating scales varied from 0.38 to 0.89. 13 studies found the NDI to be unidimensional and 15 - two- or three-dimensional. The minimal detectable change varied from 3% to 27% and minimal clinically important difference from 5% to 33%. Pooled area under the curve was 0.74 (95% CI 0.68-0.80). Most studies have not detected floor or ceiling effect. Sex-related differential item functioning has been present in one study.

The NDI demonstrated good internal consistency and test-retest reliability without floor or ceiling effect. In most situations, the NDI could be considered a unidimensional scale. The NDI well correlated with the common scales of pain and disability. The minimal clinically important difference and minimal detectable change were around 15% (7.5/50 points).

This study evaluates the clinical efficacy and safety of two ultrasound (US)-guided injections of a 5 mg/1 mL low-molecular-weight peptide (LWP) solution derived from hydrolyzed bovine collagen in patients with supraspinatus partial tendon tears.

A total of 21 patients with symptomatic partial tears of the supraspinatus tendon, detected by US, were consecutively enrolled and received one injection at a baseline visit (T0) and one after two weeks (T1). The primary outcome measure was the visual analogue scale (VAS) for pain. Secondary outcomes were the shoulder pain and disability index (SPADI) total score and the safety of LWP injections. Patients were examined at baseline (T0), at a week 2 follow-up visit (T1), and at a week 12 follow-up visit (T2).

A statistically significant improvement was found for both VAS pain and SPADI total scores, between T0 and T2 visits. US-guided injections were well tolerated and, apart from one patient with a progression of a tendon tear, no adverse events were recorded.

Intratendinous tear US-guided injection therapy with an LWP solution was found to be safe and effective in improving both pain and shoulder function at a 12-week follow-up visit. The present pilot study should be considered the first step justifying a larger confirmatory investigation.

Proximal humerus fractures (PHFx) constitute around 2% of all pediatric fractures. Although younger children with displaced fractures often undergo nonoperative treatments, optimal treatment for adolescents is not well defined. The study aimed to assess the outcomes of operative versus nonoperative treatment of displaced proximal humerus fractures in adolescents via a prospective multicenter study.

This prospective study assessed adolescents aged 10 to 16 years with displaced PHFx from 2018 to 2022 at 6 level 1 trauma centers. Displacement criteria for inclusion were >50% shaft diameter or angulation >30 degrees on AP/lateral shoulder X-rays. Operative versus nonoperative treatment was decided by the treating physician. Radiographic and clinical data were collected at 6 weeks, 3, and 6 months. Patient-reported outcomes (PROs) included: Patient Reported Outcome Measures (PROMIS), Shoulder Pain and Disability Index (SPADI), and QuickDASH questionnaires. Patients were further grouped into a severe displacement cohort, defined as angulation >40° or displacement >75%. Clinical and radiographic data were compared between the 2 treatment cohorts.

Out of 78 enrolled patients, 36 (46%) underwent operative treatment. Patients treated operatively were significantly older (13.5 vs. 12.2 y, P <0.001) and exhibited greater mean angulation on AP shoulder view at presentation (31.1° vs. 23.5°, P <0.05). All PROs improved over time. At 6 weeks, operative patients demonstrated superior PROMIS upper extremity scores based on the minimally clinically important difference (MCID) (46.4 vs. 34.3, P =0.027); however, this distinction disappeared by 3 months. In a subanalysis of 35 patients with severe displacement, 21 (60.1%) underwent surgical intervention. No metrics showed significant differences between treatment modalities, with all PROs achieving population norm values by 3 months. Range of motion showed no difference between operative and nonoperative treatments, irrespective of fracture displacement.

We found no differences in PROs and ROM between operative and nonoperative treatments of PHFx. If not contraindicated, nonoperative treatment may reduce healthcare costs and risks associated with surgery and should be considered for displaced adolescent proximal humerus fractures, irrespective of fracture displacement.

II.

In people with shoulder pain, what is the effect of adding mobilisation with movement (MWM) to a standard exercise program on function and pain compared with sham MWM and the same exercise program?

A randomised trial with concealed allocation, blinded outcome assessment and intention-to-treat analysis.

Seventy people with chronic atraumatic rotator cuff related pain, with a mean age 48 years (SD 10).

The experimental group received MWM plus exercise and the control group received sham MWM plus exercise. Treatments were delivered twice per week for 5 weeks.

The primary outcome measures were function (0 to 100 Shoulder Pain and Disability Index) and pain (0 to 10 Numerical Pain Rating Scale). Secondary outcomes were self-efficacy, perceived improvement and active pain-free range of movement. Assessment time points were at baseline (week 0), the end of the treatment period (week 5) and a follow-up 1 month after the end of treatment (week 9).

At week 5, the experimental group improved more than the control group in function (MD -15 points, 95% CI -24 to -7), pain at night (MD -2.1, 95% CI -3.1 to -1.1), pain on movement (MD -1.5, 95% CI -2.5 to -0.6) and active range of movement in flexion (MD 16 deg, 95% CI 1 to 30), abduction (MD 23 deg, 95% CI 6 to 40), external rotation (MD 11 deg, 95% CI 4 to 17) and hand behind back (MD 20 deg, 95% CI 8 to 32). At week 9, benefits were seen in the Shoulder Pain and Disability Index (MD -9 points, 95% CI -17 to -1), pain at night (MD -1.9, 95% CI -2.9 to -0.8) and on movement (MD -1.3, 95% CI-2.3 to -0.3). The effects of the experimental intervention on other outcomes were mostly unclear due to wide confidence intervals. Blinding was successful.

Adding MWM to exercise improved function, pain and active range of movement in people with shoulder pain. These benefits were not placebo effects.

NCT04175184.

OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups' sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for ≥3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):1-10. Epub 25 July 2024. doi:10.2519/jospt.2024.12512.

There are several therapeutic options for the management of shoulder adhesive capsulitis (AC). The superiority of arthro-distension over intra-articular steroid injection (ISI) for AC remains controversial.

To evaluate the efficacy of a single arthro-distension procedure combined with early and intensive mobilization (ADM) and physiotherapy, versus ISI and physiotherapy, in people with AC lasting ≥3 months.

This was a prospective, 2 parallel-group, 2-center, observer-blind randomized controlled trial conducted in tertiary care settings. Adults with AC were randomly assigned to the treatment or control group. Efficacy was assessed using the self-administered Shoulder Pain and Disability Index (SPADI). Total, pain and disability SPADI scores 15 days, 6 weeks, and 3, 6 and 12 months after the procedure (total SPADI at 15 days: primary outcome; other outcomes were secondary) were compared between groups using analysis of covariance (ANCOVA). A post hoc analysis stratified on the initial range of passive glenohumeral abduction, which had not been pre-specified, was conducted.

There were 33 participants in each group. Both groups improved over time. Mean (SD) total SPADI score at 15 days was 33.8 (19.6) in the treatment group and 32.8 (17.5) in the control group, p = 0.393. There were no significant differences for any variables in the overall sample. The post hoc analysis found ADM to be associated with a significant decrease in total SPADI score at 15 days compared with ISI (p = 0.049) in individuals with initial passive glenohumeral abduction >45°.

The effects of ADM on pain and function were not statistically different from those of ISI. However, ADM may be useful in individuals with initial passive glenohumeral abduction >45°.

NCT00724113.

The purpose of this study was to evaluate the clinical and functional outcomes in patients who underwent surgical treatment for rotator cuff tears using open and arthroscopic techniques, and to evaluate the direct costs involved.

Retrospective cohort study with analysis of the data of patients who were referred to two private hospitals in Sao Paulo, Brazil for surgical repair of the rotator cuff from January 2018 to September 2019. Clinical outcomes were assessed using functional scores (SPADI and QuickDASH) and a quality of life questionnaire (EuroQoL). Procedure costs were calculated relative to each hospital's costliest procedure.

Data from 362 patients were analyzed. The mean patient age was 57 years (SD= 10.46), with a slight male predominance (53.9%). Arthroscopic procedures were more common than open procedures (95.6% versus 4.4%). Significant clinical improvement was reported in 84.8% of the patients. The factors associated with increased surgery costs were arthroscopic technique (increase of 29.2%), age (increase of 0.6% per year), and length of stay (increase of 18.9% per day of hospitalization).

Rotator cuff repair surgery is a highly effective procedure, associated with favorable clinical outcomes and improvement in life quality, and low rates of complications. Arthroscopic surgery tends to be costlier than open surgery.

Open subpectoral biceps tenodesis (OSBT) with cortical button fixation has been shown to deliver acceptable results in the short and intermediate term for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a reduced risk of postoperative humeral shaft fracture. The primary purpose of this study was to determine whether OSBT with cortical button fixation results in significant improvements in patient reported outcomes (PROs) from pre-operative to long-term final follow-up.

A retrospective analysis of patients who underwent OSBT with cortical button fixation at a single institution between the years of 2012 and 2014 was conducted and PROs were collected in the intermediate (> 2 years follow-up) and long term (> 9 years follow-up). PROs were measured pre-operatively, at intermediate follow-up, and at long-term follow-up using three validated questionnaires: American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Oxford Shoulder Score (OSS). Patients were additionally asked at final follow-up if they would undergo the same procedure again if they needed it.

Twenty-nine (29) patients with a mean age of 51.16 ± 9.06 years at the time of surgery were included in the study at final follow-up. Mean final follow-up time was 10.2 ± 0.5 years (range: 9.2-11.1 years). All PROs (ASES, OSS, and DASH) demonstrated statistically significant improvements from pre-operative to final follow-up with p < 0.01 for each. The proportions of patients exceeding established values for minimum clinically important difference (MCID) were 96.55%, 93.10%, and 75.86% for ASES, OSS, and DASH respectively. Only one patient had required re-operation as of final follow-up. None experienced humeral fractures post-operatively. A significant majority (89.66%; p < 0.01) of patients reported that they would undergo the same procedure again if they needed it. Fifty-three (53) patients were included in the study at intermediate follow-up with a mean follow-up time of 3.5 ± 1.4 years (range: 2-5.3 years). There were no statistically significant differences in any of the PRO measures from intermediate to long-term follow-up.

This study reported a minimum 9-year follow-up of patients undergoing OSBT with cortical button fixation for the management of LHBT pathology in the setting of concomitant shoulder procedures. All patients had significantly improved functional outcomes assessed with ASES, OSS, and DASH and no obvious differences in median group scores were found between patients assessed at intermediate (mean 3.5 years) and final (mean 10.2 years) follow-up. No infections, fractures, or fixation failures were reported.

the pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS.

to compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals.

cross-sectional study.

Thirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level.

Patients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups.

A clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. To the best of our knowledge, no studies have compared the effects of Kinesio taping (KT) and cold therapy (CT) on individuals with RCT. To this end, this study aimed to investigate and compare the short-term effects of KT and CT on pain relief and upper extremity functionality in individuals with RCT. Materials and Methods: One hundred and fourteen individuals were assessed for eligibility. Fifty-two individuals with RCT who met the inclusion criteria and agreed to participate were randomly allocated into either the KT or the CT group. A standardized home exercise program was given to all the participants. Their pain intensity, upper extremity function, shoulder range of motion (ROM), and grip strength were evaluated initially and after the three days of KT or CT applications. Results: All the assessment values significantly improved in the KT group. In the CT group, only the pain scores (except for the numerical rating scale (NRS) pain score during activity) were significantly improved in the CT group at the end of the third day of application compared to the initial values (p < 0.05). For all the measurement outcomes, the effects of time × group interactions were statistically significant (p < 0.05) in favor of the KT group, except for the resting pain (p = 0.688). Conclusions: The findings suggest that KT and CT could be used as adjunctive modalities to exercise for resting and night pain relief in patients with RCT. KT also had positive effects on the activity pain, function, ROM, and grip strength. The use of KT along with an exercise program could be a more effective therapeutic choice than the use of CT for improving night pain, activity pain, and upper extremity function during the short-term rehabilitation of RCT patients.

Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time.

To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders.

Prospective, single-blind, randomized controlled trial.

Two physical medicine and rehabilitation clinics.

Ninety-four patients with frozen shoulders enrolled in a previous study.

Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method.

The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively.

The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.

Recent biomechanical evidence suggests that shoulder impingement syndrome (SIS) is closely linked with altered core-shoulder kinetic chain, resulting pain, altered external shoulder muscle activation, and external muscle weakness. We aimed to compare the effects of conventional isolated shoulder exercise (ISE) and core-shoulder chain exercises (CCE) during isokinetic shoulder rotation in baseball pitchers with SIS. Forty male college baseball pitchers with SIS were randomly allocated to ISE and CCE groups and they performed the exercises 3 times a week for 6 weeks. The standardised numerical pain rating scale (NPRS), shoulder pain and disability index (SPADI), electromyography (EMG) amplitude, and concentric (CON) and eccentric (ECC) torques were measured. Substantial improvements in NPRS and SPADI scores were observed after CCE compared to ISE (p ≤ 0.046). Internal oblique/transversus abdominis, rectus abdominis, external oblique, serratus anterior, and infraspinatus muscle activation were significantly higher after CCE than ISE (p ≤ 0.033). CON and ECC torques were higher after CCE than ISE (p ≤ 0.002). The present findings demonstrated superior therapeutic effects of CCE in improving pain, disability level, shoulder muscle activation, and torque (muscle strength) in baseball pitchers with SIS compared to the conventional ISE, highlighting the importance of the chain exercise concept.

Previous studies have indicated that mind-body exercises can reduce pain and improve function for patients with musculoskeletal conditions. Yi Jin Bang is a novel home-based Chinese mind-body Qigong exercise for shoulder pain. However, few studies have evaluated its effects on subacromial pain syndrome. This study aimed to compare the effects of Yi Jin Bang with conventional exercises for subacromial pain syndrome.

Adults with subacromial pain syndrome (N = 105; mean [SD] age, 37 [16] years; 73 females [70%]; median [IQR] duration of symptoms, 12 [6-24] months) were randomly assigned to either the experimental group (n = 53) or the control group (n = 52). The experimental group performed home-based Yi Jin Bang exercises, whereas the control group performed home-based conventional exercises (stretching, strengthening, and motor control exercises). Both interventions were performed four times a week for 16 weeks. The primary outcome was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes included current shoulder pain intensity, active shoulder range of motion, back scratch test, isometric shoulder strength, and health-related quality of life. Assessments were performed at baseline and weeks 4, 8, 12, and 16. The primary endpoint was week 16.

No significant between-group difference was observed in the SPADI score at week 16 (mean difference, Yi Jin Bang minus conventional exercise, 0.14, 95% confidence interval -2.96 to 3.24; p = 0.93).

There were no differences between Yi Jin Bang and conventional exercises in improving pain, disability, shoulder mobility, shoulder strength, and quality of life for people with subacromial pain syndrome.

We compared the effects of early and delayed rehabilitation on the function of patients after rotator cuff repair by meta-analysis to find effective interventions to promote the recovery of shoulder function.

This meta-analysis was registered in PROSPERO (CRD42023466122). We manually searched the randomized controlled trials (RCTs) in the Cochrane Library, Pubmed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), the China VIP Database (VIP), and the Wanfang Database to evaluate the effect of early and delayed rehabilitation after arthroscopic shoulder cuff surgery on the recovery of shoulder joint function. Review Manager 5.3 software was used to analyze the extracted data. Then, the PEDro scale was employed to appraise the methodological quality of the included research.

This research comprised nine RCTs and 830 patients with rotator cuff injuries. According to the findings of the meta-analysis, there was no discernible difference between the early rehabilitation group and the delayed rehabilitation group at six and twelve months after the surgery in terms of the VAS score, SST score, follow-up rotator cuff healing rate, and the rotator cuff retear rate at the final follow-up. There was no difference in the ASES score between the early and delayed rehabilitation groups six months after the operation. However, although the ASES score in the early rehabilitation group differed significantly from that in the delayed rehabilitation group twelve months after the operation, according to the analysis of the minimal clinically important difference (MCID), the results have no clinical significance.

The improvement in shoulder function following arthroscopic rotator cuff surgery does not differ clinically between early and delayed rehabilitation. When implementing rehabilitation following rotator cuff repair, it is essential to consider the paradoxes surrounding shoulder range of motion and tendon anatomic healing. A program that allows for flexible progression based on the patient's ability to meet predetermined clinical goals or criteria may be a better option.