Citations
To investigate the causes and characteristics of golf-related shoulder injuries in Korean amateur golfers.
Golf-related surveys were administered to, and ultrasonography were conducted on, 77 Korean amateur golfers with golf-related shoulder pain. The correlation between the golf-related surveys and ultrasonographic findings were investigated.
The non-dominant shoulder is more likely to have golf-related pain and abnormal findings on ultrasonography than is the dominant shoulder. Supraspinatus muscle tear was the most frequent type of injury on ultrasonography, followed by subscapularis muscle tear. Investigation of the participants' golf-related habits revealed that only the amount of time spent practicing golf was correlated with supraspinatus muscle tear. No correlation was observed between the most painful swing phases and abnormal ultrasonographic findings. Participants who had not previously visited clinics were more likely to present with abnormal ultrasonographic findings, and many of the participants complained of additional upper limb pain.
Golf-related shoulder injuries and pain are most likely to be observed in the non-dominant shoulder. The supraspinatus muscle was the most susceptible muscle to damage. A correlation was observed between time spent practicing golf and supraspinatus muscle tear.
Citations
To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain.
Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks.
Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001).
Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain.
Citations
To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome.
In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed.
VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were –1.69±1.90 and –0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were –1.60±1.74 and –0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were –1.61±1.73 and –0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05).
rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.
Citations
Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews
Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended.
Citations
To investigate the effects of glenohumeral internal rotation deficit (GIRD) on the isokinetic strength, body pain, and the quality of life in male high school baseball players of Korea.
Fifty-six male high school baseball players were divided into either group A (GIRD≥20°, n=12) or group B (GIRD<20°, n=44). The range of motion in the shoulder and the isokinetic strength were measured. Questionnaires were administered regarding the body pain location by using the visual analogue scale, and the quality of life was measured by using the SF-36 Form.
All subjects had increased external rotation range of motion and decreased internal rotation in the throwing shoulder. The incidence of GIRD (≥20°) was 21.43% in the present study. In the isokinetic strength test, a significantly weaker muscular state at an angular velocity of 180°/s was observed in group A, compared to group B. For the comparison of the pain, the frequency of shoulder pain was higher (33.93%) than other body pain, among the study subjects.
GIRD is one of the main risk factors of glenohumeral joint damage, and it is correlated with reduced isokinetic strength and quality of life. High school baseball players will need appropriate shoulder rehabilitation programs for the improvement in their quality of life and performance.
Citations
To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain.
A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS).
US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (ДVAS=-2.8) was significantly larger than caused by oral NSAID (ДVAS=-1.5) (p<0.05).
In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle.
Citations
To assess the relative effectiveness of three injections methods suprascapular nerve block (SSNB) alone, intra-articular steroid injection (IAI) alone, or both-on relief of hemiplegic shoulder pain.
We recruited 30 patients with hemiplegic shoulder pain after stroke. SSNB was performed in 10 patients, IAI in 10 patients, and a combination of two injections in 10 patients. All were ultrasonography guided. Each patient's maximum passive range of motion (ROM) in the shoulder was measured, and the pain intensity level was assessed with a visual analogue scale (VAS). Repeated measures were performed on pre-injection, and after injection at 1 hour, 1 week, and 1 month. Data were analyzed by Kruskal-Wallis and Friedman tests.
All variables that were repeatedly measured showed significant differences in shoulder ROM with time (p<0.05), but there was no difference according injection method. In addition, VAS was statistically significantly different with time, but there was no difference by injection method. Pain significantly decreased until a week after injection, but pain after a month was relatively increased. However, pain was decreased compared to pre-injection.
The three injection methods significantly improved shoulder ROM and pain with time, but no statistically significant difference was found between them.
Citations
Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to candida is very rare. However, the incidence of invasive candidal infection caused by intravenous drug use, broad-spectrum antibiotics, and indwelling central venous catheter is increasing. A 73-year old man visited the outpatient clinic complaining of right shoulder pain that radiated to the right acromioclavicular joint. He had undergone multiple injection procedures followed by nonsteroidal anti-inflammatory drug therapy for several weeks. The ultrasonographic findings showed a heterogeneous mass around the right acromioclavicular joint, while the right shoulder MRI and the overall findings of the body bone scan were suggestive of osteomyelitis. Pathologic findings of ultrasonographically guided joint aspiration fluid showed acute and chronic nonspecific inflammation, while the tissue culture and staining revealed Candida parapsilosis.
Citations
Method: Sixty shoulders in hemiplegic patients with shoulder pain were evaluated by physical examination, visual analogue scale, plain X-ray, arthrogram, ultrasonography and 3-phasic bone scan.
Results: The subluxation of shoulder on X-ray was found in 45 patients. The abnormal findings of arthrogram were 39 patients and the most common finding was adhesive capsulitis. The abnormal findings of ultrasonography were 45 patients and the most common finding was supraspinatus tendinitis. In cases of shoulder subluxation on X-ray, many cases were associated with supraspinatus tendinitis on ultrasonography and with adhesive capsulitis on arthrogram. In comparison with the arthrogram and ultrasonography, partial and complete rotator cuff tear findings show consistency. And patients with adhesive capsulitis on arthrogram show significantly high incidence of biceps tendinitis finding on ultrasonography.
Conclusion: In hemiplegic patients with shoulder pain, the ultrasonography is more valuable and useful as an invasive diagnositc method for the evaluation of rotator cuff tendinitis especially when there is subluxation in X-ray and adhesive capsulitis in physical examination. (J Korean Acad Rehab Med 2003; 27: 293-299)
Objective: The aim of this study is to know the usefulness of ultrasonographic evaluation of hemiplegic shoulder pain.
Method: For 20 hemiplegic patients with shoulder pain, the shoulder was evaluated by simple radiographic findings, physical examinations, visual analogue scale (VAS), manual muscle test (MMT), and finally the ultrasonographic examination to define shoulder pain nature. The ultrasonographic results were compared to the simple radiography, physical examination, VAS, and MMT.
Results: The ultrasonographic findings were variable. The positive ultrasonographic findings were 10 joint fluid collections, 3 tendinous thickenings, 4 high echogenic findings, 4 tendon surface defects, 2 tendinous gracilings, and 1 joint surface irregularity. The ultrasonographic interpretative conclusion included 6 tendon (or muscle) tears, 2 degenerative changes, 5 nonspecific simple joint fluid collections, and 7 normal shoulder joints. In comparison of ultrasonographic findings and subluxation, VAS, and fluid collection, VAS showed relatively higher correlation.
Conclusion: The ultrasonography is very useful as a non-invasive, inexpensive, painless, and rapid screening diagnostic method for the evaluation of painful hemiplegic shoulder.
Shoulder pain is the one of the most frequent and serious complicatsion in hemiplegia, which impedes effective rehabilitation. A prospective study was performed to evaluate the shoulder pain, related causative factors and radiologic findings in 35 stroke patients. Triphasic bone scan and simple radiologic evaluation of shoulder were performed at the beginning of rehabilitation treatment. The degree of shoulder pain, spasticity, passive range of motion(ROM) and subluxation were evaluated weekly and followed up for at least 3 months.
The incidence of shoulder pain was 62.9%(22/35). It developed in 5.7±2.7 weeks after the onset of stroke. The muscle tone was increased slightly and mean modified Ashworth scale was 0.77±0.69 at the onset of shoulder pain. The duration of flaccid stage was longer in patients with shoulder pain than in patients without shoulder pain. The degree of spasticity was inversely correlated well with shoulder pain(r=-0.43, P<0.05). The shoulder pain was also correlated well with the degree of uptake in triphasic bone scan(r= 0.61, P<0.05). The more limited ROM of shoulder presented, the more severe pain was. However, there was no relationship between shoulder pain and the degree of subluxation.
Therefore, a special precaution is needed to prevent shoulder pain in flaccid stage and the triphasic bone scan is a useful study in predicting shoulder pain in hemiplegic patients.
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