Category Archives: Shoulder

Massage therapy for neck and shoulder pain

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Objective. To evaluate the effectiveness of massage therapy (MT) for neck and shoulder pain. Methods. Seven English and Chinese databases were searched until December 2011 for randomized controlled trials (RCTs) of MT for neck and shoulder pain. The methodological quality of RCTs was assessed based on PEDro scale.
The meta-analyses of MT for neck and shoulder pain were performed. Results. Twelve high-quality studies were included.

In immediate effects, the meta-analyses showed significant effects of MT for neck pain (standardised mean difference, SMD, 1.79; 95% confidence intervals, CI, 1.01 to 2.57; P < 0.00001) and shoulder pain (SMD, 1.50; 95% CI, 0.55 to 2.45; P = 0.002) versus inactive therapies. And MT showed short-term effects for shoulder pain (SMD, 1.51; 95% CI, 0.53 to 2.49; P = 0.003). But MT did not show better effects for neck pain (SMD, 0.13; 95% CI, -0.38 to 0.63; P = 0.63) or shoulder pain (SMD, 0.88; 95% CI, -0.74 to 2.51; P = 0.29) than active therapies.

In addition, functional status of the shoulder was not significantly affected by MT.

Conclusion. MT may provide immediate effects for neck and shoulder pain. However, MT does not show better effects on pain than other active therapies. No evidence suggests that MT is effective in functional status.

Massage therapy for neck and shoulder pain: a systematic review and meta-analysis.
Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, Fang M.
Evid Based Complement Alternat Med. 2013;2013:613279. doi: 10.1155/2013/613279. Epub 2013 Feb 28.

Trigger points and shoulder injury

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Researchers of the University of Granada, Spain, conducted a research on chronic impingement syndrome. The study revealed that excessive activation of specific neck and shoulder muscles during daily life or while playing sports –as swimming– is the cause of a high number of injury and shoulder.

The pattern of the pain originated in these muscles –sometimes in regions far from the shoulder– coincides with most of the symptoms suffered by patients attending health care centers for this type of problem. 25 out of 1,000 visits to the family doctor are related to shoulder pain, and the causes of this problem are several. The chronic impingement syndrome is considered the main cause for shoulder pain and disability.

The study was designed to find the differences in the presence of trigger points (TrPs) in the shoulder muscles and to investigate the presence of mechanical hypersensitivity in patients with unilateral shoulder impingement and healthy controls. Twelve patients with strictly unilateral shoulder impingement and 10 matched controls were recruited. TrPs in the levator scapula, supraspinatus, infraspinatus, subscapularis, pectoralis major, and biceps brachii muscles were explored. TrPs were considered active if the local and referred pain reproduced the pain symptoms and the patient recognized the pain as a familiar pain. Pressure pain thresholds (PPT) were assessed over the levator scapulae, supraspinatus, infraspinatus, pectoralis major, biceps brachii, and tibialis anterior muscles. Both explorations were randomly done by an assessor blinded to the subjects’ condition.

Patients with shoulder impingement have a greater number of active and latent TrPs when compared to controls. Active TrPs in the supraspinatus (67%), infraspinatus (42%), and subscapularis (42%) muscles were the most prevalent in the patient group.
Patients showed a significant lower PPT in all muscles when compared to controls. Within the patient group a significant positive correlation between the number of TrPs and pain intensity. Active TrPs in some muscles were associated to greater pain intensity and lower PPTs when compared to those with latent TrPs in the same muscles.
Patients with shoulder impingement showed widespread pressure hypersensitivity and active TrPs in the shoulder muscles, which reproduce their clinical pain symptoms. Our results suggest both peripheral and central sensitisation mechanisms in patients with shoulder impingement syndrome.

Reference

Hidalgo-Lozano A, Fernández-de-Las-Peñas C, Alonso-Blanco C, Ge HY, Arendt-Nielsen L, Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Experiment Brain Research 2010 Feb 26.

Young Men and Elderly Women at Biggest Risk for Shoulder Dislocations

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The shoulder joint is the most mobile joint in the body and consequently one of the most commonly dislocated joints.

An article published in the March 2010 issue of The Journal of Bone and Joint Surgery (JBJS) reveals that the majority of all shoulder dislocations occur during sports activities and young males are at a higher risk. The study also shows a high rate of shoulder dislocation in elderly women.
The overall incidence rate was 23.9 shoulder dislocations per 100,000 person years (the product of the number of years times the number of members of a population who have been affected by a certain condition). While this is more than double the previous rate reported for shoulder dislocations for the U.S. general population, it is still less than the rates of other common musculoskeletal injuries seen in emergency rooms, such as injuries to the lower back, knee and foot.
“Shoulder instability is one of the most common reasons young athletes see orthopaedic surgeons,” explained Brett Owens, MD, study co-author, orthopaedic surgeon at Keller Army Hospital in West Point, New York and Associate Professor at the Uniformed Services University of the Health Sciences. “However little has been reported about the incidence of this injury.”
Dr. Owens and his colleagues studied 8,940 shoulder dislocations in patients presenting to 100 hospital emergency rooms across the United States from 2002 to 2006. The purpose of the study was to identify the specific groups of individuals at risk, to help direct prevention efforts.
Of all dislocations, the study found:
71.8 percent were in men;
46.8 percent were in patients between 15-29 years;
48.3 percent occurred during sports or recreation; and
37 percent of all sports-related injuries were football or basketball related.
Dislocations most frequently resulted from a fall (58.8 percent), of which 47.7 percent of these falls occurring at home and 33.6 percent occurring at recreation or sports sites.
In women, higher dislocation rates were seen among those aged 80 to 90 years old. This increase was mostly due to falls at home.
“We were not too surprised to find the high number of young males dislocating their shoulders during athletic activity,” commented Dr. Owens. “However, the rate of shoulder dislocations among elderly women was higher than we had previously assumed.”
The shoulder joint can dislocate forward, backward or downward. The most common shoulder dislocation happens when the shoulder slips forward (anterior instability). The arm bone is moved forward and down and out of its joint.
Dislocated shoulder symptoms include:
pain;
swelling;
numbness;
weakness; and
bruising.
Often the dislocation will tear ligaments or tendons in the shoulder or even damage nearby nerves. To treat the dislocation, the doctor must manipulate the arm bone (the humerus) and replace it in the shoulder socket. This stops the severe pain and allows for the injured tissues to heal.
“Individuals who dislocate their shoulders should see an orthopaedic surgeon. While not all patients require surgery, an orthopaedist can best counsel patients on the treatment options and expected outcomes,” said Dr. Owens.

Healing a shoulder separation

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Disagreement exists on how to treat a mid-level, common injury

IMAGE: This figure shows the normal bony anatomy of the area. The red arrow points to the joint that comes apart in a shoulder separation injury.

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ROSEMONT, IL–While low-level shoulder separations can commonly be treated nonsurgically and high-level injuries often require surgery, a literature review published in the April 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) finds that many surgeons still disagree on the best course of treatment for those injuries that fall in between.

  • Shoulder separations, clinically known as acromioclavicular joint injuries, represent nearly half of all athletic shoulder injuries.
  • These injuries result from a fall onto the tip of the shoulder with the arm tucked in toward the body.

“Shoulder separation” is not a truly accurate term for this type of injury, which is not a separation of the shoulder joint itself, but rather a disruption or dislocation of the acromioclavicular joint (also called the AC joint), where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion).

IMAGE: This figure shows the intact ligaments around the acromioclavicular joint. The red arrow points to the ligaments that are around the joint itself. The gray arrow points out the important…

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If the force of the fall is severe enough, the ligaments attaching to the underside of the clavicle may also be torn. The severity or “type” of injury is classified by the amount and direction of joint separation seen on x-rays. If the underside of the clavicle is torn, it is referred to as a major injury. Signs and symptoms of AC joint injuries range from a minor deformity and mild pain, to a very painful, severe deformity. However, even more serious separations can often be treated successfully with proper attention.

“AC joint injuries are not benign and should not be ignored,” says Ryan Simovitch, MD, orthopaedic surgeon specializing in the shoulder, Palm Beach Orthopaedic Institute, Palm Beach Gardens, Florida. “Nonsurgical treatment does not mean you can neglect the injury. Many patients who follow appropriate treatment and a rehabilitation program can have clinical success without surgery. At the same time, surgery has an important role in high grade injuries.”

Nonsurgical options – which help treat the injury and manage pain for minor sprains (clinically called type I and II AC joint injuries) of the shoulder ligaments include:

  • slings
  • cold packs
  • over-the-counter pain and anti-inflammatory medications

Sometimes, other types of supports may be used to help lessen AC joint motion and reduce pain. Surgery is almost always recommended for major or high level injuries (also called type IV, V, and VI injuries), as well as less serious injuries that do not respond to nonsurgical treatment. Both surgical and nonsurgical types of treatment must include rehabilitation to restore and rebuild the patient’s motion, strength, and flexibility.

The treatment of the mid level injuries (type III) remains controversial, with nonsurgical treatment favored in most instances and surgical reconstruction of the acromioclavicular joint reserved for cases in which the joint demonstrates persistent instability.

“Nearly 50 years after the initial papers describing type III acromioclavicular joint injuries, there is still a lack of consensus on the best treatment for them,” Simovitch says. “So far, most studies do not show a significant difference in outcomes between nonsurgically and surgically treated patients with this type of injury. Also, while most orthopaedic surgeons agree that type IV and higher injuries should be treated surgically, we haven’t reached a consensus on which surgical technique is best. Over the years, however, arthroscopic and open treatment options for AC joint reconstruction have made significant advances.”

Although the issue has not been fully researched, the study authors suggest that certain patients with Type III injuries, such as heavy laborers and athletes who perform frequent overhead motions, might benefit more from surgical reconstruction.