Thoracic Manual Therapy Improves Pain and Disability in Individuals With Shoulder Impingement Syndrome Compared With Placebo: A Randomized Controlled Trial With 1-Year Follow-up

ObjectiveTo investigate whether muscle energy technique (MET) to the thoracic spine decreases the pain and disability associated with shoulder impingement syndrome (SIS).DesignSingle-center, 3-arm, randomized controlled trial, single-blind, placebo control with concealed allocation and a 12-month follow-up.SettingPrivate osteopathic practice.ParticipantsThree groups of 25 participants (N=75) 40 years or older with SIS received allocated intervention once a week for 15 minutes, 4 consecutive weeks.InterventionsParticipants were randomly allocated to MET to the thoracic spine (MET-only), MET plus soft tissue massage (MET+STM), or placebo.Main Outcome MeasuresPrimary outcome measure: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary outcome measures: Shoulder Pain and Disability Index (SPADI) questionnaire; visual analog scale (VAS) (mm/100): current, 7-day average, and 4-week average; Patient-Specific Functional Scale (PSFS); and Global Rating of Change (GROC). Measures recorded at baseline, discharge, 4-week follow-up, 6 months, and 12 months. Also baseline and discharge thoracic posture and range of motion (ROM) measured using an inclinometer. Statistical analysis included mixed-effects linear regression model for DASH, SPADI, VAS, PSFS, GROC, and thoracic posture and ROM.ResultsMET-only group demonstrated significantly greater improvement in pain and disability (DASH, SPADI, VAS 7-day average) than placebo at discharge (mean difference, DASH=?8.4; 95% CI, ?14.0 to ?2.8; SPADI=?14.7; 95% CI, ?23.0 to ?6.3; VAS=?15.5; 95% CI, ?24.5 to ?6.5), 6 months (?11.1; 95% CI, ?18.6 to ?3.7; ?14.9; 95% CI, ?26.3 to ?3.5; ?14.1; 95% CI, ?26.0 to ?2.2), and 12 months (?13.4; 95% CI, ?23.9 to?2.9; ?19.0; 95% CI, ?32.4 to ?5.7; ?17.3; 95% CI, ?30.9 to ?3.8). MET+STM group also demonstrated greater improvement in disability but not pain compared with placebo at discharge (DASH=?8.2; 95% CI, ?14.0 to ?2.3; SPADI=?13.5; 95% CI, ?22.3 to ?4.8) and 6 months (?9.0; 95% CI, ?16.9 to ?1.2; ?12.4; 95% CI, ?24.3 to ?0.5). For the PSFS, MET-only group improved compared with placebo at discharge (1.3; 95% CI, 0.1-2.5) and 12 months (1.8; 95% CI, 0.5-3.2); MET+STM at 12 months (1.7; 95% CI, 0.3-3.0). GROC: MET-only group improved compared with placebo at discharge (1.5; 95% CI, 0.9-2.2) and 4 weeks (1.0; 95% CI, 0.1-1.9); MET+STM at discharge (1.2; 95% CI, 0.5-1.9) and 6 months (1.2; 95% CI, 0.1-1.3). There were no differences between MET-only group and MET+STM, and no between-group differences in thoracic posture or ROM.ConclusionsMET of the thoracic spine with or without STM improved the pain and disability in individuals 40 years or older with SIS and may be recommended as a treatment approach for SIS.     

Effectiveness of translational manipulation under interscalene block for the treatment of adhesive capsulitis of the shoulder: A nonrandomized clinical trial

Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC.     

Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study

ObjectivesTo investigate the effect of hypertonic dextrose injection on pain and disability in patients with chronic supraspinatus tendinosis. The secondary aim was to evaluate its effect on the tendon range of motion (ROM) and morphology.DesignRandomized double-blind placebo-controlled trial.SettingOutpatient clinic.ParticipantsIndividuals (N=57) with symptomatic chronic supraspinatus tendinosis.InterventionsParticipants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (study group, n=29) or 5% normal saline (control group, n=28).Main Outcome MeasuresThe primary outcome measure was visual analog scale (VAS) scores for pain and Shoulder Pain and Disability Index (SPADI) scores. Secondary outcomes included the ROM and ultrasound examination findings of the supraspinatus tendon at baseline and at 2, 6, and 12 weeks postintervention.ResultsThe study group exhibited significant improvements in the VAS (mean difference [MD], ?2.1; 95% confidence interval [CI], ?2.7 to ?1.4; P<.001) and SPADI (MD, ?11.6; 95% CI, ?16.5 to ?6.7; P<.001) scores compared with baseline scores at week 2. However, the effect was not sustained to week 6. Flexion ROM increased at weeks 2 (MD, 14.1; 95% CI, 5.7-22.5; P<.001) and 6 (MD, 8.9; 95% CI, 2.4-15.4; P=.003) compared with baseline. The thickness of the supraspinatus tendon improved at weeks 6 (MD, .50; 95% CI, .26-.74; P<.001) and 12 (MD, .61; 95% CI, .37-.84; P<.001) compared with baseline. The ratio of histograms also improved at weeks 6 (MD, .19; 95% CI, .06-.32; P=.002) and 12 (MD, .26; 95% CI, .10-.41; P<.001) compared with baseline.ConclusionHypertonic dextrose injection could provide short-term pain and disability relief in patients with chronic supraspinatus tendinosis. Ultrasound imaging at week 6 revealed changed tendon morphology.     

Reliability and relationship of the fear-avoidance beliefs questionnaire with the shoulder pain and disability index and numeric pain rating scale in patients with shoulder pain

Purpose: The purpose of this study was to determine: 1) the test–retest reliability of Fear-Avoidance Beliefs Questionnaire (FABQ) Work (FABQW) subscale, FABQ Physical Activity (FABQPA) subscale, Shoulder Pain and Disability Index (SPADI) Pain subscale, SPADI Disability subscale, and Numeric Pain Rating scale (NPRS); and 2) the relationship between the FABQPA, FABQW, SPADI pain, SPADI disability, and NPRS after 4 weeks of pragmatically applied physical therapy (PT) in patients with shoulder pain. Design: Prospective, single-group observational design. Methods: Data were collected at initial evaluation, the first follow-up visit prior to the initiation of treatment, and after 4 weeks of treatment. Results: Statistically significant Intraclass Correlation Coefficient (ICC_2,1) values were reported for the FABQPA, FABQW, SPADI Pain, SPADI Disability, and NPRS. A statistically significant moderate relationship between the FABQPA subscale, SPADI subscale, and NPRS could not be established prior to and after 4 weeks of pragmatically applied PT. Statistically significant differences were observed between the initial evaluation and four-week follow-up for the FABQPA, SPADI Pain, SPADI Disability, and NPRS (p < 0.01). Discussion: Since a meaningful relationship between the FABQ, SPADI, and NPRS did not exist, it suggests that the FABQPA may be measuring a metric other than pain. Conclusions: This study suggests that the FABQW may not be sensitive to change over time.     

Translational manipulation under anesthesia for patients with frozen shoulder: a case series study with five-year health care utilization and post-manipulative arthroscopic findings

Study Design: Case series study.

Objectives: Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA.

Methods: Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury.

Results: Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulder-related health care. Surgical evaluation revealed no evidence of iatrogenic injury.

Discussion: Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study.

Level of Evidence: Therapy, Level 4.     

Ultrasound-Guided Standard vs Dual-Target Subacromial Corticosteroid Injections for Shoulder Impingement Syndrome: A Randomized Controlled Trial

ObjectiveTo compare dual-target injection with standard ultrasound (US)-guided subacromial injection in patients with subacromial impingement syndrome (SIS) and possible disorders of the biceps long-head tendons.DesignDouble-blind, randomized controlled trial.SettingRehabilitation outpatient clinic.ParticipantsPatients with SIS (N=60).Intervention(1) US-guided standard subacromial bursa; (2) dual-target (subacromial bursa plus proximal biceps long-head tendon) injection, with 40-mg triamcinolone acetonide administered to patients in each group.Main Outcome MeasuresClinical assessments were performed at baseline. The outcomes, including results from a self-administered questionnaire, the Shoulder Pain and Disability Index (SPADI), and a self-pain report, the visual analog scale (VAS) scores for pain at rest, at night, and during overhead activities, were evaluated at baseline and at the first and third months postintervention.ResultsNo significant difference was observed in baseline evaluations between groups (n=30 in each treatment arm) prior to injections. Both groups exhibited significant SPADI and VAS-score improvements after the first month. The dual-target injection group had less rebounding pain at the 3-month follow-up. The standard injection group had more patients reporting worsening pain within 1 day postinjection.ConclusionUS-guided dual-target corticosteroid injection showed similar short-term efficacy to standard subacromial injections, but with an extended duration of symptom relief. Therefore, dual-target corticosteroid injections may be useful for shoulder pain treatment in patients with SIS.     

温针灸治疗肩袖损伤的效果北大核心CSCD

目的观察温针灸对肩袖损伤患者的治疗效果。方法2019年1月至2020年1月,福建中医药大学附属康复医院肩袖损伤患者70例随机分为对照组(n=35)和试验组(n=35),两组均接受Mulligan动态关节松动术和肩袖肌群肌肉能量技术(MET)治疗,试验组另于肩髃、巨骨、肩前、肩贞予温针灸,连续治疗2周。治疗前后采用肩关节疼痛与功能障碍指数(SPADI)、疼痛视觉模拟量表(VAS)、肩关节活动度(ROM)、肩关节等速肌力测试进行评定,随访观察并发症发生和复发情况。结果对照组脱落5例,试验组脱落4例。治疗后,两组SPADI评分、VAS评分均显著降低(|t|>5.039,P<0.001),ROM、等速肌力测试R值明显提高(|t|>2.751,P<0.01)。试验组SPADI评分、VAS评分显著低于对照组(|t|>3.616,P<0.001);ROM,前屈、后伸、内收、外展等速肌力测试R值高于对照组(|t|>2.214,P<0.05)。结论温针灸联合康复训练可进一步缓解袖损伤患者肩关节疼痛,提高肩关节活动度,促进肌力恢复,改善肩关节功能。     

不同剂量地佐辛联合利多卡因用于宫腔镜检的麻醉效果:一项倾向配比研究

目的:比较不同剂量地佐辛联合利多卡因用于门诊宫腔镜检查的临床效果。方法:回顾性分析2020年1月至12月在上海交通大学医学院附属第九人民医院辅助生殖科门诊接受宫腔镜检查的888例患者的临床资料,分为低剂量地佐辛组(L组)424例、高剂量地佐辛组(H组)464例,分别于术前5 min单次静脉注射地佐辛0.02、0.04 mg/kg,同时行2%利多卡因5 mL宫颈旁局部阻滞麻醉。根据患者临床特征进行倾向性配比,筛选出816例,每组408例。比较两组患者术中视觉模拟评分(VAS)、体动发生率、Ramsay镇静评分,术前术中心率(HR)、收缩压(SBP)、舒张压(DBP)、氧饱和度(SpO_2),以及术后恶心呕吐(PONV)等情况。结果:倾向性配比后,两组患者的年龄、体质量、手术时间、美国麻醉医师协会(ASA)分级,以及术前术中HR、SBP、DBP、SpO_2等差异均无统计学意义。H组患者术中VAS评分、体动发生率、Ramsay镇静评分均明显优于L组(P0.01)。两组PONV发生率差异无统计学意义。结论:较大剂量地佐辛(0.04 mg/kg)静脉注射联合利多卡因局部麻醉对于接受门诊宫腔镜检查的患者具有较好的镇痛镇静作用,同时不良反应较小。     

Short-term effect of myofascial trigger point dry-needling in patients with Adhesive Capsulitis

BackgroundAdhesive Capsulitis (AC) is a common disabling musculoskeletal pain condition of unknown etiology related to the shoulder joint. Literature reported the restricted range of motion (ROM) and pain could be the result of myofascial trigger points (MTrPs) in the muscles of the shoulder girdle. Hence, the objective of this study was to assess the short-term effectiveness of MTrP dry needling (DN) in improving ROM, pain, pressure pain threshold (PPT), and physical disability among patients having AC.MethodsIn a single group pre-post experimental study design, a total of 70 clinically diagnosed patients (both male & female, age group between 40 and 65 years) with AC were recruited from three multi-specialty hospitals. The informed consent forms were received from each patient before participating in the study. Each patient received DN for the MTrPs of shoulder girdle muscles for alternative six days. In addition to DN, each patient had received conventional physiotherapy for continuous twelve days which includes electrotherapy modalities and exercises. The pain intensity (visual analog scale), shoulder ROM (Goniometer), disability (shoulder pain and disability index) and PPT (Algometer) were the outcome measures assessed at the baseline and twelfth day of the intervention.ResultsThere was a statistically significant (p < 0.05) improvement in shoulder ROM, pain intensity, shoulder disability, and PPT at the end of the twelve days of intervention as compared to baseline assessment.ConclusionMTrPs-DN techniques may improve the pain, ROM, disability and PPT along with conventional physiotherapy management among patients with AC.     

Clinical and radiological outcomes of dynamic cervical implant arthroplasty: A 5-year follow-up

BACKGROUNDDynamic cervical implant (DCI) stabilization has been reported to have satisfactory clinical and radiological results with short- and mid-term follow-up in the treatment of cervical degenerative disc disease. However, few reports about the clinical and radiological outcome with more than 5-year follow-up exist.AIMTo investigate the long-term clinical and radiological results of DCI arthroplasty.METHODSA total of 40 patients who received DCI arthroplasty were consecutively reviewed from May 2010 to August 2015. Visual analogue scale (VAS), neck disability index (NDI) score, Japanese Orthopaedic Association (JOA) score, and SF-36 items were used to assess neural function rehabilitation. Static and dynamic radiographs and 3-dimentional computed tomography were used to evaluate the radiological outcomes.RESULTSThe scores of neck/arm VAS, NDI, JOA, and 8-dimensions of SF-36 were significantly improved at the 1-mo follow-up (P < 0.05) and maintained until the last follow-up (P < 0.05). The range of motion (ROM) of C2-C7, functional spinal unit (FSU), upper/lower adjacent level, C2-C7 lateral bending, and FSU lateral bending decreased at the 1-mo follow-up (P < 0.05), whereas they increased to the preoperative level at the later follow-up intervals (P > 0.05), except the ROM of FSU lateral bending (P < 0.05). The C2-C7 alignment and FSU angle kept more lordotic at the last follow-up (P < 0.05). The intervertebral height increased significantly at the 1-mo follow-up (P < 0.05) and decreased at later follow-ups (P > 0.05). At the last follow-up, 12 (26.1%) segments developed heterotopic ossification.CONCLUSIONDCI arthroplasty is a safe and effective non-fusion technique to treat cervical degenerative disc disease in long-term follow-up.     

Intravenous Lidocaine for the Emergency Department Treatment of Acute Radicular Low Back Pain,a Randomized Controlled Trial

Background

Acute radicular back pain is a frequent complaint of patients presenting to the Emergency Department.

Study Objective

Determine the efficacy of intravenous lidocaine when compared to ketorolac for the treatment of acute radicular low back pain.

Methods

Randomized double-blind study of 41 patients aged 18–55 years presenting with acute radicular low back pain. Patients were randomized to receive either 100 mg lidocaine or 30 mg ketorolac intravenously over 2 min. A 100-mm visual analog scale (VAS) was used to assess pain at Time 0 (baseline), and 20, 40, and 60 minutes. Changes in [median] VAS scores were compared over time (within groups) by the signed-rank test and between groups by the rank-sum test. A 5-point Pain Relief Scale (PRS) was administered at the conclusion of the study (60 min) and again at 1 week by telephone follow-up; [median] scores were compared between groups by rank-sum.

Results

Forty-four patients were recruited; 41 completed the study (21 lidocaine, 20 ketorolac). Initial VAS scores were not significantly different between the lidocaine and ketorolac groups (83; 95% confidence interval [CI] 74–98 vs. 79; 95% CI 64–94; p = 0.278). Median VAS scores from baseline to 60 min significantly declined in both groups (lidocaine [8; 95% CI 0–23; p = 0.003]; ketorolac [14; 95% CI 0–28; p = 0.007]), with no significant difference in the degree of reduction between groups (p = 0.835). Rescue medication was required by 67% receiving lidocaine, compared to 50% receiving ketorolac. No significant change in PRS between groups was found at the conclusion or at the follow-up.

Conclusion

Intravenous lidocaine failed to clinically alleviate the pain associated with acute radicular low back pain.     

Calcific tendinopathy of the rotator cuff. Conservative management with 434 Mhz local microwave diathermy (hyperthermia): A case study

Purpose. To report the effects of local microwave diathermy (hyperthermia) at 434 Mhz on calcific tendinopathy of the shoulder in two middle aged patients.

Methods. Two middle-aged women with calcific tendinopathy of the shoulder were treated with local microwave diathermy (hyperthermia) at 434 Mhz three times a week for four weeks. Plain radiographs and ultrasonography demonstrated calcific deposits in the area of infraspinatus or supraspinatus. Shoulder Pain and Disability Index (SPADI) and passive Range of Motion (ROM) were used to assess the response to treatment.

Results. At the end of the treatment period, the improvement as measured by the SPADI score was respectively 30% for the first patient and 40% for the second patient with an improvement of the shoulder passive ROM for both patients. The calcific deposits seen on the initial radiographs and ultrasonography were no longer visible. At 1 year follow-up, both patients continued to be symptom free.

Conclusions. Hyperthermia is a safe option in the management of calcific tendinopathy of the shoulder. Prospective randomized controlled studies with long term assessment are needed to further document its therapeutic efficacy.     

Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial

BackgroundPosterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization.ObjectiveTo assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms.MethodsIn this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration.ResultsIndividuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P<.01; MD=-0.7mm; 95%CI=-1.3mm, -0.2mm) and superior (P<.01; MD=-0.5mm; 95%CI=-0.9mm, -0.2mm) humeral translations, decreased SPADI score (P<.01; MD=-23.6; 95%CI=-28.7, -18.4), increased IR ROM (P<.01; MD=4.6°; 95%CI=1.8°, 7.8°) and PPTs for upper trapezius (P<.01; MD=60.1kPa; 95%CI=29.3kPa, 90.9kPa), infraspinatus (P=.04; MD=47.3kPa; 95%CI=2.1kPa, 92.5kPa), supraspinatus (P<.01; MD=63.7kPa; 95%CI=29.6kPa, 97.9kPa), and deltoid (P<.01; MD=40.9kPa; 95%CI=12.3kPa, 69.4kPa) after treatment.ConclusionThe experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.     

Interferential laser therapy in the treatment of shoulder pain and disability from musculoskeletal pathologies: a randomised comparative study

BackgroundInterference is an important feature of the waves. When two or more in phase light waves meet, a new and reinforced wave is generated. Shoulder pain is a common clinical problem and laser is one of the treatments frequently used to relieve it.ObjectiveTo test the safety of interferential laser therapy generated by two independent low level lasers and compare its effectiveness with conventional single laser therapy in the reduction of shoulder musculoskeletal pain and associated disability.DesignRandomised and single-blind controlled clinical trial.SettingPhysiotherapy Unit and Rehabilitation Department of Ramon y Cajal University Hospital (Madrid).Participants200 patients with shoulder musculoskeletal pain were randomly assigned in two groups, 100 people each.InterventionsGroup I, experimental (n=100) received interferential laser, placing two probes opposite each other over the shoulder joint. Group II, control (n=100) received conventional laser therapy, using a single probe along with a second inactive dummy probe. Lasers used were GaAlAs diode (810 nm, 100 mW), in continuous emission. Laser was applied in contact mode through ten sessions, on 5 shoulder points (7 Joules/point) per session.Main Outcome MeasuresVisual Analogue Scale (VAS) score and Shoulder Pain Disability index (SPADI), recorded before and after laser treatment.ResultsThere were no differences between both groups in the reduction of pain, either assessed by VAS scale (median difference=0, 95% CI of the difference =-.6 to .5, p=0.81) or SPADI index (median difference = .4, 95% CI of the difference =-2.9 to 3.8, p=0.80), using the Mann-Whitney U-test. Comparison between the scores recorded before and after the treatment, within each group, showed significant differences for VAS during movement (median difference=3, 95% CI of the difference =2.07 to 4, p<0.001) and SPADI index (median difference=3.5, 95% CI of the difference =2.67 to 3.85, Wilcoxon test, p<0.001), for both groups.ConclusionsIn this study, the application of two low level lasers in order to generate interference inside the irradiated tissue showed to be a safe therapy. Both interferential and conventional laser therapy reduced shoulder pain and disability. Nevertheless, differences between them were not detected. Future research in this field could include applying this technique with other laser parameters or application forms.     

Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction

Objectives

The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment.

10% Lidocaine spray as a local anesthetic in blood gas sampling: A randomized,double-blind,placebo-controlled study

AimRadial artery blood gas sampling is a very common procedure undertaken in the emergency department to evaluate respiratory and metabolic parameters. This intervention causes both anxiety and pain for the patient. Therefore, the current study aimed to examine the analgesic efficacy of lidocaine spray compared to a placebo during radial artery blood gas sampling.MethodsThis study was conducted in the emergency department of a tertiary hospital with a randomized, double-blind, placebo-controlled design. A total of 144 patients were randomly divided into two groups: One group (n = 72) received 10% lidocaine spray and the other (n = 72) was the placebo group. The analgesic efficacy of the 10% lidocaine spray was compared with the placebo group using the Visual Analog Scale (VAS).ResultsIn the evaluation of the analgesic efficacy of the 10% lidocaine spray, the VAS score was 1.5 [interquartile range (IQR): 2.0] for the lidocaine group and 5 (IQR: 2.0) for the placebo group. The role of lidocaine spray in reducing pain was statistically significant compared to the placebo (p = 0.000).ConclusionIn blood gas sampling, 10% lidocaine spray has analgesic efficacy. Therefore, we recommend the use of lidocaine spray while performing arterial blood gas sampling in emergency departments.     

Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial

Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial.ObjectiveTo compare the efficacy of intra-articular hyaluronic acid (HA) injections plus physical therapy (PT) with that of PT alone for the treatment of adhesive capsulitis (AC) of the shoulder.DesignProspective, randomized controlled trial.SettingRehabilitation and orthopedics department of a private teaching hospital.ParticipantsPatients (N=70) with AC of the shoulder were randomly placed into either of the following treatment groups: group 1, HA injections with PT (HAPT group); or group 2, PT alone (PT group).InterventionsThe patients in group 1 received intra-articular glenohumeral joint injections of HA, 20mg, once per week for 3 consecutive weeks and also participated in a PT program for 3 months. The patients in group 2 received PT alone.Main Outcome MeasuresActive and passive range of motion (ROM) of the affected shoulder, pain, disability, and quality of life.ResultsBoth groups experienced improvements in terms of pain, disability, and quality of life after the treatments; furthermore, the active and passive ROM improved linearly with increasing treatment duration. When the groups were compared, no significant group effect was found for any of the outcome measurements.ConclusionsIntra-articular HA injections did not produce added benefits for patients with AC of the shoulder who were already receiving PT. Thus, the use of intra-articular HA injections for patients with AC of the shoulder should be carefully assessed to reduce unnecessary medical expenditures.     

Indian (Marathi) version of the Shoulder Pain and Disability Index (SPADI): Translation and validation in patients with adhesive capsulitis

Background:The Shoulder Pain and Disability Index (SPADI) is the most commonly used self-administered questionnaire which is a valid and reliable instrument to assess the proportion of pain and disability in shoulder disorders. There is no evidence of SPADI questionnaire being translated into regional Indian language (Marathi).Objective:This study aims to translate and culturally adapt and validate the Marathi version of the SPADI questionnaire. This was done as per the AAOS outcomes committee guidelines.Methods:Cross-cultural adaptation and psychometric testing of SPADI was done in the Outpatient Physiotherapy Department of Tertiary Care Hospital, Ahmednagar, India.Results:The internal consistency was assessed by calculating Cronbach alpha value for the pain score (0.908), disability score (0.959), and total SPADI (0.969) which were all high. The Test–retest reliability was assessed using the intraclass correlation coefficient (ICC) values for the pain score (0.993), disability score (0.997), and total SPADI (0.997) which showed excellent reliability. The criterion validity was assessed using Pearson correlation coefficient. In Males, weak to strong negative correlation was observed except for shoulder extension and in females, moderate negative correlation was observed between baseline shoulder range of motion and initial total SPADI scores and individual pain and disability except for shoulder internal rotation. The internal consistency of the Marathi SPADI (Cronbach’s alpha >0.99) was higher than the original English version. The reliability of the total Marathi SPADI and its subscale (Intraclass correlation coefficient >0.90) were found to be higher than that of the English SPADI and were consistent with the German, Brazilian, Slovene and Greek versions.Conclusion:The translated and culturally adapted Marathi version of the SPADI questionnaire is a reliable and valid tool for the assessment of pain and disability in Marathi population.     

Effectiveness of Botulinum Toxin A in Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-analysis

ObjectiveTo evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain.Data SourcesPubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020.Study SelectionRandomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included.Data ExtractionOutcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale [VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators.Data SynthesisMeta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference [SMD], 0.91; 95% confidence interval [CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group.ConclusionsBTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP.