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The important role played by the rotator cuff in the stability and movement of the glenohumeral joint make it susceptible to damage and injury in patients of all age groups. A number of extrinsic and intrinsic mechanisms have been described for the development of rotator cuff disease, although it is more likely that the actual etiology in any one i...
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Context 1
... sports [14,15]. These shoulders are susceptible to injury and dysfunction because of the high mechanical and repetitive stresses placed on them in the extremes of motion. Damage to the various static and dynamic stabilizers often leads to the development of a complex interrelation between instabil- ity, impingement, and rotator cuff disease (Fig. 2) ...
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Background
Platelet-derived lyophilized growth factors (L-GF) uses a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. This study aimed to evaluate the efficacy of L-GF injection versus placebo in the treatment of subacromial impingement (SIS).
Methods
The current ran...
Posterosuperior impingement (PSI) is an underdiagnosed cause of posterior shoulder pain and should be differentiated from classic and external impingement. PSI involves the internal impingement of soft tissues, including the undersurface of the rotator cuff against the posterosuperior labrum when the arm is brought into abduction and external rotat...
Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain in adults and is caused by muscle imbalance around the shoulder joint, which is referred to as secondary SIS. Centralization of the glenohumeral joint (CGH), one of the intervention methods for this, targets strengthening the control ability of the rotator cuff...
We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag...
Objectives
Subacromial Impingement Syndrome (SIS) is thought to be the most common cause of isolated shoulder pain. SIS is the abnormal contact of the soft tissues of the subacromial space with the inferior aspect of the anterolateral acromial arch. The actual in vivo pathophysiology of subacromial impingement is still not well-understood. Current...
Citations
... Rotator cuff disorders encompass a broad spectrum of conditions affecting tendons of rotator cuff muscles ranging from inflammation to tears or rupture [5]. There is no universally accepted way to label or define shoulder tendinopathies [6]. ...
... The overall quality score ranges from 3 to 17. According to tertile distribution, studies were classified into three categories, namely: low-quality (3)(4)(5)(6)(7), medium-quality (8)(9)(10)(11)(12), and high-quality studies (13)(14)(15)(16)(17). To evaluate the causal relationship between shoulder tendinopathies and occupational exposure to biomechanical risk factors, a slightly modified version of the criteria developed by The Scientific Committee of the Danish Society of Occupational and Environmental Medicine was used [12,14]. ...
Background:
The aim of this study is to evaluate the association between occupational exposure to biomechanical risk factors and shoulder tendinopathies.
Methods:
We updated recent systematic reviews about specific shoulder disorders and work-related risk factors. MEDLINE was searched up to September 2022. Studies satisfying the following criteria were included: i) the diagnosis was based on physical examination plus imaging data (when available), and ii) the exposure assessment was based on video analysis and/or directly measured.
Results:
Five studies met the inclusion criteria: three cross-sectional studies identified from published systematic reviews and two cohort studies retrieved from the update. Two studies investigated shoulder tendinitis, one supraspinatus tendinitis, and the other two rotator cuff syndrome. The diagnosis was based on physical examination, not supported by imaging techniques for all the included studies. In four out of five studies, the exposure was assessed by experienced ergonomists with the support of video recordings. In two studies, the exposure assessment was further supplemented by force gauge measurements or direct measurements of upper arm elevation. Only the combined exposure of working with arms above shoulder level with forceful hand exertion appears to be associated with rotator cuff syndrome: i) a cohort study reported an HR=1.11 (95%CI 1.01-1.22) for each unit increase in forceful repetition rate when the upper arm is flexed ≥45° for ≥29% of the working time; and ii) a cross-sectional study showed an OR=2.43 (95%CI 1.04-5.68) for the combination of upper arm flexion ≥45° for more than 15% of the time with a duty cycle of forceful exertions more than 9% of the time.
Conclusions:
There is moderate evidence of a causal association between shoulder tendinopathy and combined exposures of working above shoulder level with forceful hand exertion. The evidence is insufficient for any single biomechanical exposure on its own. High-quality cohort studies with direct exposure measures and objective diagnostic criteria are needed. The occupational origin of shoulder tendinopathies is still an open question that must be properly answered.
... The rotator cuff plays an important role in stability and movement of glenohumeral joint, making it more susceptible to the injury. (1) The prevalence of rotator cuff tears ranged 40-57%, however it is problematic to determine the exact prevalence, as the rotator cuff tears are mostly asymptomatic. About 1/3 rd asymptomatic injuries may appear or become symptomatic after several years. ...
Background: Shoulder pain during sleep leads to poor quality sleep. It is a common problem in patients with Rotator cuff syndrome. Rotator cuff syndrome is a condition where your rotator cuff tendons are intermittently trapped and pinched during shoulder movements Objective: To evaluate the relationship between sleep quality and nocturnal pain in patients of rotator cuff syndrome. Methods: Current study was conducted in orthopedic and physiotherapy department of Jinnah Hospital Lahore. Cross-sectional survey was used in this study. Subjects with age group 18-75 years, both genders, diagnosed with rotator cuff syndrome with positive shoulder impingement test and empty can test were included. Patients were requested to fill the comprehensive questionnaire about current medical history, shoulder pain, impact on daily life activities and quality of sleep. Patients with coexisting neck pain and radiculopathies (spleen, kidney, gallbladder) and also with other disabilities e.g., osteoarthritis, rheumatoid arthritis, back pain were excluded from current study. Thirty-six patients were enrolled and examined by using Pittsburgh Sleep Quality Index (PSQI). Data was analyzed using SPSS 20.0. Results: The results showed that sleep quality was disturbed in patients of rotator cuff syndrome with a mean Pittsburgh Sleep Quality Index score of 11.3333. The results showed that among 36 patients, 18 (50%) had moderate disturbance of sleep as calculated by PSQI scale and 11 (30.6%) had severe disturbance of sleep while 7 (19.4%) had mild disturbance of sleep due to rotator cuff syndrome. Conclusion: The current study concluded that subjective sleep disturbance connected to shoulder pain was obvious in patients with rotator cuff syndrome. Patients experienced low quality of sleep associated with rotator cuff syndrome and affected their activities of daily living causing severe pain and physical disability.
... consequence of intrinsic and extrinsic factors, including anatomical and biomechanical dysfunctions in addition to age-related injuries (tendon degeneration, poor vascularization) and overuse in relation to specific sports and professions [6][7][8]. This is a spectrum of pathologies that include simple tendonitis, calcifications and tendon tears. ...
Background
Kinesiotaping (KT) is widely used in several musculoskeletal disorders particularly in shoulder pain. However, literature shows controversial results regarding the effect of KT on shoulder pathology. The aim of this study was to assess the clinical effects of KT in the short term on rotator cuff tendinopathy (RCT).
Methods
A randomized controlled double-blind clinical trial was conducted. The sample consisted of 50 subjects (25 per group). Patients were randomly assigned to the KT group (to receive therapeutic KT application) or to the placebo group (to receive sham KT application). Taping was applied every 4 days, a total of three times during the study period. We assessed the patients at baseline, at the end of taping period (D12), and at one-month post-taping (D30). Primary outcome was assessed through the Arabic version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Secondary outcomes were assessed through Visual Analogue Scale (VAS) for pain intensity at rest (VASr), during active movement (VASm), and at night (VASn).
Results
There were no significant differences between the two groups in the demographic and clinical characteristics and the pre-test scores. Results of repeated measures ANOVA showed significant improvement in DASH scores and in VAS for pain (at rest, during active movement and at night) from D12 in both groups. The use of ANCOVA, controlling for pre-test scores, showed no significant differences between groups, except for VASm at D30.
Conclusion
This study showed that the standardized therapeutic KT used for shoulder pain was not superior to a sham KT application in improving pain and disabilities in patients with RCT.
Trial registration
The study was retrospectively registered on Pan African Clinical Trial Registry (identification number: PACTR202007672254335) on 21/07/2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12200
... Treatment of shoulder pain usually consists of conservative management with non-operative treatments (i.e. medications, physical therapy, patient education, and assistive devices) (6,7). If pain persists for 6 months, rotator cuff surgery is often recommended. ...
Introduction:
Shoulder pain is common in persons with chronic spinal cord injury (SCI), with a prevalence reported as high as 70%. Current treatment of shoulder pain includes conservative measures such as physical therapy, pain medications, patient education, injections, and assistive devices. When conservative treatments fail, shoulder surgery is often the next option. Unfortunately, outcomes after shoulder surgery in persons with SCI are limited and conflicting.
Case presentation:
This is a case of a 54-year-old right-handed male with T10 complete SCI (duration of injury = 10 years) who had a complaint of right-sided shoulder pain for 3 years. The individual used a manual wheelchair as his primary means of mobility and was an avid weight-lifter. Physical examination and MRI demonstrated a rotator cuff tear and degenerative changes of the acromioclavicular joint. He was previously managed conservatively with physical therapy and intermittent corticosteroid injections but failed to improve. He was enrolled in an IRB approved study and underwent an ultrasound-guided injection with autologous, micro-fragmented adipose tissue (MFAT) and ultimately received improvements in pain and function that were maintained a year after treatment.
Discussion:
To our knowledge, this is the first reported case of treatment of chronic refractory shoulder pain in a person with SCI using MFAT. Complete relief from pain was maintained at the 1-year follow-up. Injection of MFAT under ultrasound guidance is an effective and promising treatment for chronic refractory shoulder pain in upper limb-dependent persons with SCI and warrants further research.
... Our results provide an explanation for the progression of mechanical damage in collagen-rich tissues, as well as implications for initiation of the inflammatory response and subsequent healing. It is now widely accepted that overuse tendinopathies involve tissue microtrauma or subfailure damage, which causes measurable changes in tissue scale material properties, and often progress to observable and symptomatic damage in the form of partial and full tendon tears [1][2][3][4] . Our cyclic fatigue experiments demonstrated that collagen molecular damage can accumulate with repeated subfailure loading at quasi-static and physiological loading frequencies (Fig. 5) and that this molecular level damage is correlated with changes in tissue material behaviour ( Supplementary Fig. 2). ...
Mechanical injury to connective tissue causes changes in collagen structure and material behaviour, but the role and mechanisms of molecular damage have not been established. In the case of mechanical subfailure damage, no apparent macroscale damage can be detected, yet this damage initiates and potentiates in pathological processes. Here, we utilize collagen hybridizing peptide (CHP), which binds unfolded collagen by triple helix formation, to detect molecular level subfailure damage to collagen in mechanically stretched rat tail tendon fascicle. Our results directly reveal that collagen triple helix unfolding occurs during tensile loading of collagenous tissues and thus is an important damage mechanism. Steered molecular dynamics simulations suggest that a likely mechanism for triple helix unfolding is intermolecular shearing of collagen α-chains. Our results elucidate a probable molecular failure mechanism associated with subfailure injuries, and demonstrate the potential of CHP targeting for diagnosis, treatment and monitoring of tissue disease and injury.
... The important role played by the rotator cuff in the stability and mobility of the glenohumeral joint makes it susceptible to damage and injuries [1,2]. The etiology of rotator cuff injury is probably multifactorial [3]. ...
... 24,47 A combination of some extrinsic and intrinsic factors are generally responsible for the development of RCT, including biomechanical and anatomic dysfunctions causing subacromial impingement, tendon degeneration associated with aging, alterations in tendon mechanical properties, poor vascularity, tension overload, and overuse. 23,41,43 Rotator cuff lesions begin with acute tendinitis and then progress to chronic tendinosis and partial tears. The final stage is full-thickness tears and complete ruptures of the tendon. ...
Background:
Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT.
Purpose:
To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT.
Study design:
Randomized controlled trial; Level of evidence, 1.
Methods:
A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week standard exercise program. Outcome measures (Western Ontario Rotator Cuff Index [WORC], Shoulder Pain and Disability Index [SPADI], 100-mm visual analog scale [VAS] of shoulder pain with the Neer test, and shoulder range of motion) were assessed at baseline and at 3, 6, 12, and 24 weeks and 1 year after injection.
Results:
Comparison of the patients revealed no significant difference between the groups in WORC, SPADI, and VAS scores at 1-year follow-up (P = .174, P = .314, and P = .904, respectively). Similar results were found at other assessment points. Within each group, the WORC, SPADI, and VAS scores showed significant improvements compared with baseline at all time points (P < .001). In the range of motion measures, there were no significant group × time interactions.
Conclusion:
At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.
... [10][11][12][13][14][15][16][17][18] A breakdown of instrument injury prevalence has shown that right shoulder injuries are present in 16% of orchestral cellists, placing them in a similar category to other high-risk occupations such as welders, painters and over-head athletes. 8,[19][20][21] Motion capture studies on cello bowing have found that cellists adopt similar positions of abduction and flexion seen in these professions. [20][21][22] Given that recent studies have found that shoulder injuries amongst musicians have very poor rehabilitation outcomes, further investigation into causes and prevention strategies for right shoulder injuries in cellists is warranted. ...
... 8,[19][20][21] Motion capture studies on cello bowing have found that cellists adopt similar positions of abduction and flexion seen in these professions. [20][21][22] Given that recent studies have found that shoulder injuries amongst musicians have very poor rehabilitation outcomes, further investigation into causes and prevention strategies for right shoulder injuries in cellists is warranted. 2 Because of lack of research into cellorelated injuries, currently, no model exists for possible causal factors. ...
Cellists sustain high levels of playing-related injury and are particularly susceptible to right shoulder pain, yet no studies have attempted to propose a mechanism for disease or establish possible causal factors. The aim of this study was to investigate shoulder injury levels and causes in two populations: professional orchestral cellists and college-level student cellists.
A questionnaire and physical testing protocol was applied to both groups of participants, eliciting information on lifestyle, playing habits, and self-reported injury rates as well as physical data on shoulder strength, range of motion, and signs of injury.
Right shoulder injuries are common among both student (20%) and professional (42%) cellists and seem to be associated with measures indicating potential lack of strength in the scapular stabilisers as well as potential degenerative changes in the rotator cuff. Significant differences were found in the lifestyle and playing habits of the two groups. There were increased signs of pain and stiffness in the professionals and evidence of decreased muscular support in the students. Male cellists showed less scapular stability; female cellists, however, generally had higher levels of pain.
These results indicate that injuries at the shoulder, potentially involving impingement-type pathologies, are a common cause of pain in cellists. Based on this study, future research for cello players could focus on targeted interventions, such as exercises for the scapular stabilisers and muscles of the rotator cuff.
... Diagnostic labels are commonly applied to patients with shoulder pain, such as capsulitis, bursitis and subacromial impingement syndrome [7], but the pathophysiology of shoulder disorders is still unclear [8][9][10][11][12]. A large number of tests are used for examination of the shoulder that are purported to be indicative of these diagnostic labels, but there are a number of problems underlying these tests. ...
Shoulder pain is a common clinical problem, and numerous tests are used to diagnose structural pathology.
To systematically review the reliability of physical examination procedures used in the clinical examination of patients with shoulder pain.
MEDLINE, PEDro, AMED, PsychInfo, Cochrane Library (2009) and CINAHL were searched from the earliest record on the database to June 2009.
Reliability studies that included any patients with shoulder pain were analysed for their quality and reliability results.
Pre-established criteria were used to judge the quality of the studies (high quality >60% methods score) and satisfactory levels of reliability (kappa or intraclass correlation coefficient > or =0.85, sensitivity analysis 0.70). A qualitative synthesis was performed based on levels of evidence.
Thirty-six studies were included with a mean methods score of 57%. Seventeen studies were deemed to be of high quality; high-quality studies were less likely to meet the pre-agreed level of reliability. The majority of studies indicated poor reliability for all procedures investigated.
Overall, the evidence regarding reliability was contradictory.
There is no consistent evidence that any examination procedure used in shoulder assessments has acceptable levels of reliability. Alternate methods of classification which are reliable should be used to classify patients with shoulder problems.
... These poor healing rates are independent of the surgical procedure used [6][7][8] and the poor healing is statistically linked to a negative clinical outcome [6]. Several extrinsic and intrinsic mechanisms have been proposed to explain the development of rotator cuff disease [3,[9][10][11]. One reason for this failure after repair is the age of the surrounding tissues. Fresh, limited lesions heal more rapidly in healthy patients [6]. ...
... Many elements are involved in this particular biomechanical function, but a main one is the presence of chondrocytes producing type II collagen [4,11]. Aging or acute trauma can cause the tendon to become detached from the bone by breakdown or destruction of the enthesis [5,10,11]. ...
The enthesis, which attaches the tendon to the bone, naturally disappears with aging, thus limiting joint mobility. Surgery is frequently needed but the clinical outcome is often poor due to the decreased natural healing capacity of the elderly. This study explored the benefits of a treatment based on injecting chondrocyte and mesenchymal stem cells (MSC) in a new rat model of degenerative enthesis repair.
The Achilles' tendon was cut and the enthesis destroyed. The damage was repaired by classical surgery without cell injection (group G1, n = 52) and with chondrocyte (group G2, n = 51) or MSC injection (group G3, n = 39). The healing rate was determined macroscopically 15, 30 and 45 days later. The production and organization of a new enthesis was assessed by histological scoring of collagen II immunostaining, glycoaminoglycan production and the presence of columnar chondrocytes. The biomechanical load required to rupture the bone-tendon junction was determined.
The spontaneous healing rate in the G1 control group was 40%, close to those observed in humans. Cell injection significantly improved healing (69%, p = 0.0028 for G2 and p = 0.006 for G3) and the load-to-failure after 45 days (p<0.05) over controls. A new enthesis was clearly produced in cell-injected G2 and G3 rats, but not in the controls. Only the MSC-injected G3 rats had an organized enthesis with columnar chondrocytes as in a native enthesis 45 days after surgery.
Cell therapy is an efficient procedure for reconstructing degenerative entheses. MSC treatment produced better organ regeneration than chondrocyte treatment. The morphological and biomechanical properties were similar to those of a native enthesis.
