Epidemiology of shoulder problems

Patients undergoing rotator cuff surgery often search the internet for information regarding the procedure. One popular source, Google, compiles frequently asked questions and links to websites that may provide answers. This study provides an analysis of the most frequently searched questions associated with rotator cuff surgery. We hypothesize that there will be distinct search patterns associated with online queries about rotator cuff surgery that could provide unique insights into patient concerns.

A set of search terms were entered into Google Web Search using a clean-install Google Chrome browser. Frequently associated questions and their webpages were extracted to a database via a data mining extension. Questions were categorized by topics relevant for rotator cuff arthroscopy. Websites were categorized by source and scored for quality using the JAMA Benchmark Criteria. Pearson’s χ² tests were used to analyze nominal data. Student t tests were performed to compare JAMA Benchmark Scores.

Of the 595 questions generated from the initial search, 372 unique questions associated with 293 websites were extracted and categorized. The most popular question topics were activities/restrictions (20.7%), pain (18.8%), and indications/management (13.2%). The 2 most common websites searched were academic (35.2%) and medical practice (27.4%). Commercial websites were significantly more likely to be associated with questions about cost (57.1% of all cost questions, P = .01), anatomy/function (62.5%, P = .001), and evaluation of surgery (47.6%, P < .001). Academic websites were more likely to be associated with questions about technical details of surgery (58.1%, P < .001). Medical practice and social media websites were more likely associated with activities/restrictions (48.1%, P < .001, and 15.6%, P < .001, respectively). Government websites were more likely associated with timeline of recovery (12.8%, P = .01). On a scale of 0-4, commercial and academic websites had the highest JAMA scores (3.06 and 2.39, respectively).

Patients seeking information regarding rotator cuff repair primarily use the Google search engine to ask questions regarding postoperative activity and restrictions, followed by pain, indications, and management. Academic websites, which were associated with technical details of surgery, and medical practice websites, which were associated with activities/restrictions, were the 2 most commonly searched resources. These results emphasize the need for orthopedic surgeons to provide detailed and informative instructions to patients undergoing rotator cuff repair, especially in the postoperative setting.

There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP).

To identify the most relevant clinical descriptors for diagnosing RCRSP.

A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus.

Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the “subjective examination” domain, 1 item was included in the “patient-reported outcome measures” domain, 3 items in the “diagnostic examination” domain, 2 items in the “physical examination” domain”, and 2 items in the “functional tests” domain. No items reached consensus within the “special tests” domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus.

In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.

Kinesiotaping is widely used for the rehabilitation of rotator cuff tendinopathy. It has been argued to reduce symptoms and functional limitations through improvement of proprioceptive feedback. In addition, kinesiotaping has been reported to increase the subacromial space in healthy subjects. However, its effects on the acromiohumeral distance and shoulder proprioception of individuals with rotator cuff tendinopathy have not been ascertained. This study investigated the immediate effects of kinesiotaping on the acromiohumeral distance and shoulder proprioception in individuals with rotator cuff tendinopathy.

Twenty-two individuals with chronic rotator cuff tendinopathy were included. The acromiohumeral distance was measured using an ultrasound scanner at rest and 60° shoulder abduction. Proprioception was measured through active joint repositioning in low- (45°–65°) and mid-amplitude (80°–100°) of shoulder flexion and abduction. A wireless inertial measurement unit system was used to quantify shoulder angles. First, measurements were taken without kinesiotaping. Thereafter, kinesiotaping was applied on the symptomatic shoulder, and the same measurements were retaken. Repeated measures ANOVAs were used for statistical analyses.

Kinesiotaping induced a significant increase in acromiohumeral distance at 60° abduction (∆AHD = 0.94 mm; 95%CI: 0.50–1.38, p < 0.001), exceeding the minimal detectable change (0.70 mm). No significant difference was observed in acromiohumeral distance at rest or in proprioception during active joint repositioning in both low- and mid-amplitude (p > 0.05).

Kinesiotaping led to an immediate increase in acromiohumeral distance at 60° of abduction that, although it seems a minor change (↑10.5%), it may be significant for symptomatic patients, whereas it had no immediate effect on active joint repositioning.

To evaluate the current evidence of the effectiveness of botulinum toxin (BTX) treatment for shoulder pain.

Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus were searched from inception through week 18 of 2015.

Randomized controlled trials comparing the clinical efficacy (pain intensity and shoulder range of motion [ROM]) of BTX injection to conventional therapy (steroid or placebo injection) were included.

Two reviewers independently screened abstracts and full texts. The results of the pain intensity and shoulder ROM were extracted and presented in the form of mean and SD. We constructed random-effects models and calculated the mean difference (MD) for continuous outcomes. A total of 219 articles were identified, of which 9 articles were eligible for the final analysis.

The analysis indicated a statistically significant decreased pain score in the BTX therapy group compared with the control group, with the MD=1.35 (95% confidence interval [CI], .80–1.91; P<.001; I²=81%). Patients who received BTX therapy were more likely to have a significant increase in shoulder abduction ROM than patients in the control group, with the MD=8.02 (95% CI, 1.17–14.88, P=.02, I²=89%).

Compared with conventional (steroid or placebo injection) therapy, BTX injections have beneficial effects for adult patients with shoulder pain, evidenced by improved pain scores and ROM.

The relationship between overhead work and musculoskeletal health depends on multiple task and individual factors. Knowledge gaps persist, despite examination of many of these factors individually and in combination. This investigation targeted task variation, as parameterized by cycle time within a fixed overall workload. Participants performed an intermittent overhead pressing task with four different cycle time conditions while overall workload and duty cycle was held constant. Several manifestations of fatigue were monitored during task performance. Endurance time was influenced by cycle time with shorter cycle times having endurance times up to 25% higher than longer cycle times. Surface electromyography (sEMG) results were mixed, with two muscles demonstrating amplitude increases (middle deltoid and upper trapezius) that varied with cycle time. sEMG frequency was not influenced by cycle time for any muscle monitored, despite decreases for several cycle times. Trends existed for the influence of cycle time on time-varying reported discomfort (p=0.056) and static strength (p=0.055); large effect sizes were present (η_p²=0.31 and 0.27, respectively). The equivocal association of fatigue indicators and cycle time is analogous to the influence of other factors implicated in overhead work musculoskeletal risk, and probabilistic modeling offers a compelling avenue for integration of the known variation in the many factors that combine to inform this risk.

Worldwide, acupuncture is a popular alternative medicine for releasing pain, treating diseases, or promoting health. Although it is generally considered safe, a few complications have been reported. These complications ranged from minor side effects, such as pain, local hematoma formation, or the aggravation of symptoms, to serious complications including mechanical injuries, such as pneumothorax and severe infection requiring surgical treatment. In orthopedic clinics, reports of complications caused by acupuncture are rare. We present three cases who developed severe infection following acupuncture, leading to irreversible osteoarthritic changes in their glenohumeral joints. All of them mentioned a history of acupuncture therapy before their shoulder became swollen and hot and no other infection source could be detected. Possible explanations included: (1) breakdown of the sterile technique; (2) no consensus of acupoint or how deep the needle should be inserted; (3) patient’s comorbidities, such as diabetes mellitus or previous shoulder pathology, were not considered. Although these three patients underwent debridement and proper management with antibiotics according to the culture data, eventually, they still progressed to severe glenohumeral joint destruction. Strict infection control guidelines should be established to lower this type of life-threatening complication.