Aspects of physiotherapy in treatment of shoulder joint pain]

Shoulder joint pain occupies the second place among muscle-skeletal disorders in frequency categories. A main reason of this problem are overload, trauma, osteoartchritis or spascity after stroke. An aim of this study was to determinate an influence of crotherapy and warm radiation on effectivness of kinesitherapy in shoulder pain treatment. A group of thirty patients (20 women and 10 men in the age between 30 and 65 years old) was examined in categories of free-range movement and a strength of muscles lying near the joint. It was done before and after a treatment, which was, consists of kinesitherapy and physical procedures. Results show that a both methods are useful but cryotherapy acting a little stronger. Physiotherapy should be recommended in shoulder pain as a treatment of choice.     

A rationalized approach to physiotherapy for low-back pain

A systematic approach to low-back pain is presented that relies on the classification of patients according to their symptoms. Rational systems of physiotherapy are proposed for each group and incorporated into an algorithmn. One hundred forty-two patients with mechanical low-back pain have been treated, and their response has been assessed by means of a postal questionnaire. Patients were offered an educational program, exercises, spinal manipulation, spinal supports, and analgesic medication. Eighteen percent of patients became completely free of pain, and 59% experienced a reduction in pain level. The most effective treatment was education in back care, followed closely by an exercise program. The responses were different in the various subgroups, and a series of revised flow charts is presented.     

Arthroscopy for the diagnosis of shoulder pain

Summary Arthroscopy under anaesthesia was used to investigate 123 patients with painful shoulders. The clinical diagnosis was compared with the arthroscopic findings. Four types of rotator cuff lesions were found in which there were significant differences between sex and age. Instability detected under anaesthesia was an important cause of pain. These examinations proved valuable in the diagnosis of shoulder pain, particularly when the clinical diagnosis was uncertain.

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Résumé 123 patients souffrant de douleurs de l'épaule ont été examinés par arthroscopie et en testant la stabilité de l'épaule sous anesthésie. Le diagnostic clinique ainsi que l'âge, le sexe des patients et l'étiologie ont été comparés aux constatations arthroscopiques et les changements morphologiques notés lors de l'arthroscopie ont été enregistrés. Les modifications pathologiques de la coiffe des rotateurs ont été divisées en quatre classes qui montraient des différences significatives selon le sexe et les différents groupes d'âge. L'instabilité occulte s'est trouvée être une cause importante de douleurs de l'épaule. La combinaison arthroscopie-tests de stabilité sous anesthésie s'est avérée fort utile pour le diagnostic des douleurs de l'épaule, en particulier lorsque le diagnostic clinique était incertain.

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Reprint requests to: L. Adolfsson     

Cervical spine and shoulder pain

The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.     

Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain

OBJECTIVES: This study was designed to evaluate the effectiveness of low-volume interscalene brachial plexus block for post-thoracotomy ipsilateral shoulder pain and to compare it with nonsteroidal anti-inflammatory drug treatment. DESIGN: Prospective nonblinded study. SETTING: University hospital. PARTICIPANTS: Sixty adult patients. INTERVENTION: Patients who underwent elective thoracic surgery under combined epidural and general anesthesia, and after surgery were free of incisional pain but complaining of shoulder pain, were included in the study. They were selected in a sequential manner and placed into 2 groups of 30 patients each. Group 1 had a low-volume interscalene brachial plexus block, using 10 mL of bupivacaine 0.5%. Group 2 had an intramuscular injection of diclofenac sodium, 75 mg. MEASUREMENTS AND MAIN RESULTS: Pain was measured during their stay in the postanesthesia care unit (PACU) by using a visual analog score (VAS). Opioids were administered when pain relief was incomplete. Pain intensity was re-estimated the next morning and patient satisfaction was scored. VAS was found to be significantly lower in the low-volume interscalene block group than in the diclofenac group at 30 minutes after treatment and when leaving PACU (p < 0.001 for both). Patients in the interscalene block group stayed longer in the PACU (p = 0.019), and significantly fewer required rescue opioids (p = 0.03). There was no significant difference between the groups in patient satisfaction with the pain treatment. CONCLUSIONS: The authors concluded that low-volume interscalene brachial plexus block is a superior treatment for post-thoracotomy shoulder pain compared with diclofenac injection, although it requires a slightly longer stay in the PACU.     

An algorithm for shoulder pain caused by soft-tissue disorders

Painful shoulders are commonly caused by disorders of periarticular soft tissues, especially rotator cuff tendinopathies. In contrast to arthritic conditions of the shoulder, soft-tissue disorders can present a diagnostic dilemma that often results in the use of such nonspecific or unproved terminologies as periarthritis or bursitis. To promote an efficient use of investigative studies necessary to arrive at a proper diagnosis, an algorithm can serve as a guide for clinicians in the diagnosis and management of common, nonarthritic conditions of painful shoulders.     

The pain control infusion pump for postoperative pain control in shoulder surgery.

PURPOSE: This study was initiated to evaluate the effect of a pain control infusion catheter in managing postoperative pain. Type of Study: In a prospective, randomized trial, 62 consecutive patients undergoing arthroscopic subacromial decompression had an indwelling pain control infusion catheter placed at the operative site. Materials and Methods: Thirty-one patients received 0.25% bupivacaine and 31 patients received saline infusions, each at a constant rate of 2 mL per hour. Patients evaluated their pain by visual analog scale, and also tabulated the amount of narcotic and nonnarcotic medication used each day in the first week of surgery. RESULTS: There was a statistically significant difference in pain in all parameters tested in the bupivacaine group as compared with the saline control group (P <.05). CONCLUSIONS: The bupivacaine pain control infusion pump is an effective means of decreasing postoperative pain.     

Ultrasound-guided pain interventions in shoulder region

Shoulder pain is one of the common complaints to physicians in general practice. Among therapeutic measures used to treat this pain, invasive techniques, such as joints and periarticular injection, as well as suprascapular and axillary nerve block, play a crucial role. Ultrasound guidance is a safe alternative to blind techniques, increasing the safety and accuracy of the procedure and reducing complications. A good understanding of the anatomy and sonoanatomy is of paramount importance in performing the ultrasound-guided injections.     

Biomechanical and osteopathic approach to shoulder pain

One of the most common complaints heard by primary care physicians is shoulder pain. Yet, most shoulder discomfort can be attributed to a variety of physiologic and anatomic dysfunctions outside of the glenohumeral joint. This paper addresses the anatomic and biomechanical mechanisms of shoulder motion and presents a logical approach to diagnosis and osteopathic treatment of the sore shoulder.