scholarly journals A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study.

2020 ◽  
Author(s):  
Silvia Mena-del Horno ◽  
Lirios Dueñas Moscardó ◽  
Enrique Lluch ◽  
Adriaan Louw ◽  
Alejandro Luque-Suárez ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Pain ◽  
Treatment Program ◽  
Washout Period ◽  
Pain Catastrophizing ◽  
Frozen Shoulder ◽  
Fear Avoidance ◽  
Shoulder Flexion ◽  
Pain Sensitization

Abstract Background: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion (ROM). The aim of this study was to evaluate the feasibility and clinical impact of a CNS-focused treatment program for people with frozen shoulder (FS).Methods: 10 subjects with primary FS received a 10 weeks CNS-focused intervention including sensory discrimination training and graded motor imagery techniques delivered as clinic sessions (60 minutes) and home therapy (30 minutes five times per week). Measurements were taken at baseline, after a 2-weeks washout period, after treatment and at three months follow-up. The Shoulder Pain and Disability Index (SPADI) was the primary outcome. Secondary measures were: feasibility-related outcomes, self-reported shoulder pain, active and passive range of motion, two-point discrimination threshold (TPDT), left/right judgement task (LRJT), fear-avoidance (Tampa Scale for Kinesiophobia), pain catastrophization (Pain Catastrophizing Scale) and pain sensitization (Central Sensitization Inventory).Results: 70% of participants completed the treatment. No significant changes were found after washout period except for TPDT (p=0.02) and SPADI (p=0.025). Improvements in self-reported shoulder pain (p=0.028) and active shoulder flexion (p=0.016) were shown after treatment (p=0.028) and follow-up (p=0.001) and in SPADI at follow-up (p=0.008). No significant changes were observed in TPDT, LRJT, fear-avoidance, pain catastrophization and pain sensitization. Conclusions: a CNS-focused treatment program might be a suitable approach to improve pain and disability in FS but further research is needed to draw firm conclusions.Trial registration: Clinical Trials. NCT03320200. Registered 25 October 25 2017, https://clinicaltrials.gov/ct2/show/NCT03320200?term=NCT03320200&draw=2&rank=1

scholarly journals Effectiveness of Shock Wave Therapy versus Intra-Articular Corticosteroid Injection in Diabetic Frozen Shoulder Patients’ Management: Randomized Controlled Trial

2021 ◽  
Vol 11 (8) ◽  
pp. 3721
Author(s):  
Ahmed Ebrahim Elerian ◽  
David Rodriguez-Sanz ◽  
Abdelaziz Abdelaziz Elsherif ◽  
Hend Adel Dorgham ◽  
Dina Mohamed Ali Al-Hamaky ◽  
...  
Keyword(s):  
Shock Wave ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Corticosteroid Injection ◽  
Frozen Shoulder ◽  
Diabetic Patients ◽  
Shock Wave Therapy ◽  
Injection Group ◽  
Shoulder Flexion ◽  
Group B

Frozen shoulder is a major musculoskeletal illness in diabetic patients. This study aimed to compare the effectiveness of shock wave and corticosteroid injection in the management of diabetic frozen shoulder patients. Fifty subjects with diabetic frozen shoulder were divided randomly into group A (the intra-articular corticosteroid injection group) and group B that received 12 sessions of shock wave therapy, while each patient in both groups received the traditional physiotherapy program. The level of pain and disability, the range of motion, as well as the glucose triad were evaluated before patient assignment to each group, during the study and at the end of the study. Compared to the pretreatment evaluations there were significant improvements of shoulder pain and disability and in shoulder flexion and abduction range of motion in both groups (p < 0.05). The shock wave group revealed a more significant improvement the intra-articular corticosteroid injection group, where p was 0.001 for shoulder pain and disability and shoulder flexion and abduction. Regarding the effect of both interventions on the glucose triad, there were significant improvements in glucose control with group B, where p was 0.001. Shock waves provide a more effective and safer treatment modality for diabetic frozen shoulder treatment than corticosteroid intra-articular injection.

scholarly journals The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

2019 ◽  
Vol 33 (6) ◽  
pp. 980-991 ◽  
Author(s):  
Liesbet De Baets ◽  
Thomas Matheve ◽  
Mira Meeus ◽  
Filip Struyf ◽  
Annick Timmermans
Keyword(s):  
Surgical Treatment ◽  
Shoulder Pain ◽  
Self Efficacy ◽  
Pain Catastrophizing ◽  
Behavioral Factors ◽  
Fear Avoidance ◽  
Mediating Role ◽  
Predictive Role ◽  
Moderating Role

Objective: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. Data sources: Electronic databases (PubMed, Web of Science, Embase and PsycINFO) were searched until 14 January 2019. Study selection: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. Results: A total of 23 articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatization or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. Conclusion: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.

scholarly journals Negative Affect, Type D Personality, Quality of Life, and Dysfunctional Outcomes of Total Knee Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Matthias Vogel ◽  
Christian Riediger ◽  
Martin Krippl ◽  
Jörg Frommer ◽  
Christoph Lohmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Negative Affect ◽  
Knee Arthroplasty ◽  
Pain Catastrophizing ◽  
Fear Avoidance ◽  
Type D ◽  
Total Knee

Background. Type D personality (TDP) is a sign of tapered stress and compromises treatment outcomes including those of hip arthroplasty. The common dissatisfaction with total knee arthroplasty (TKA) is predicted by fear avoidance, pain catastrophizing and emotional lability, with poor quality of life (QoL) reflecting these strains. This study is the first to investigate the influence of TDP on TKA assuming (1) negative affect (NA) to be linked to fear avoidance and to increased dissatisfaction with TKA and (2) the expression of NA and social inhibition (SI) to not be stable over time. Method. We studied 79 participants using the brief symptom inventory-18, the pain-catastrophizing scale, the Tampa scale of kinesiophobia, the SF-36, and the WOMAC preoperatively and 12 months postoperatively. T-test and regression were used to compare the variables of interest between groups built based upon outcome severity. Result. NA at follow-up predicted knee pain (p=0.02) and knee function (p<0.01) at follow-up. Contrarily, increased expressions of NA/SI at follow-up were predicted by NA (p=0.04) and rumination (p=0.05) at the baseline. Conclusion. The present results suggest the postoperative increase of NA to be linked to dysfunctional outcomes of TKA due to an interaction with pain catastrophizing. Baseline self-rated physical health did not connect to the dissatisfaction with TKA 1-year postoperatively.

scholarly journals Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder

2016 ◽  
Vol 2 (4) ◽  
pp. 387
Author(s):  
Swapnil P. Sonune ◽  
Anil K. Gaur ◽  
Shefali Gupta
Keyword(s):  
Shoulder Pain ◽  
Nerve Block ◽  
Comparison Group ◽  
Frozen Shoulder ◽  
Ultra Sound ◽  
Ultrasound Guided ◽  
Group A ◽  
Lateral Rotation ◽  
Group B

<p class="abstract"><strong>Background:</strong> Frozen shoulder is one of the most common musculoskeletal problems seen in orthopaedics. Many treatment modes are available however, it is difficult to treat and data on the comparative efficacy of various interventions are limited. Intra-articular corticosteroid injection (IASI) is a commonly used to treat frozen shoulder pain. Supra-scapular nerve block (SSNB) is also effective method to treat pain in chronic diseases that affect the shoulder. The present study was done to compare efficacy of ultrasound guided SSNB and IASI in management of painful frozen shoulder.</p><p class="abstract"><strong>Methods:</strong> 60 patients with painful frozen shoulder were divided in two groups, Group A received ultra-sound guided SSNB with 6 ml 0.5% Bupivacaine; Group B received IASI using 40 mg Triamcinolone. Outcome measures were shoulder ranges mainly lateral rotation and abduction, shoulder pain and disability index and visual analogue scale (VAS). Patients were followed-up on 2<sup>nd</sup> day, at 1<sup>st</sup>, 3<sup>rd</sup> and 6<sup>th</sup> week.<strong></strong></p><p class="abstract"><strong>Results:</strong> All baseline parameters improved significantly in both groups; however, on comparison Group A showed significant improvement in passive lateral rotation on 2<sup>nd</sup> day and 1<sup>st</sup> week follow up (P =0.038 and 0.040 respectively). VAS score showed significance at all follow-up in Group A, whereas, in Group B significance was seen after 1 week. On inter group comparison Group A shows significance on 2<sup>nd</sup> day (P =0.050), 1<sup>st</sup> week (P =0.042) and 3<sup>rd</sup> week (P =0.036).</p><strong>Conclusions:</strong>Both SSNB and IASI have efficacy in management of frozen shoulder. But supra-scapular nerve block is better than intra-articular injection and should be considered prior to steroid as it has early onset pain relief, early improvement in ranges, potentially lesser contraindications and side effects.<p> </p>

scholarly journals Range of motion of diabetic frozen shoulder recovers to the contralateral level

2016 ◽  
Vol 44 (6) ◽  
pp. 1191-1199 ◽  
Author(s):  
Heidi Vastamäki ◽  
Leena Ristolainen ◽  
Martti Vastamäki
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Functional Results ◽  
Shoulder Range Of Motion ◽  
Constant Murley Score ◽  
Patients With Diabetes ◽  
The Mean ◽  
Shoulder Range

Objective To determine whether frozen shoulder heals equally well in patients with and without diabetes and whether dependency on insulin affects the outcome. Methods We retrospectively examined 178 patients with idiopathic frozen shoulder; 27 patients had diabetes. We evaluated range of motion, pain, and functional results. The mean follow-up was 9.7 years (SD, 7.1 years). Results In the presence of frozen shoulder, range of motion did not differ between patients with and without diabetes. At follow-up, range of motion in all directions of both the affected and unaffected shoulders of patients with diabetes was inferior to that of patients without diabetes. Among patients with diabetes, range of motion of the once-frozen shoulder reached the level of the unaffected shoulder. Patients with and without diabetes experienced similar pain except during exertion. The Constant–Murley score was not significantly different between the two groups, and insulin dependency did not lead to worse outcomes. Conclusion Frozen shoulder heals well in patients with diabetes.

Pain-related fear, catastrophizing and pain in the recovery from a fracture

2010 ◽  
Vol 1 (1) ◽  
pp. 38-42 ◽  
Author(s):  
J. Linton Steven ◽  
Nina Buer ◽  
Lars Samuelsson ◽  
Karin Harms-Ringdahl
Keyword(s):  
Pain Catastrophizing ◽  
Recovery Process ◽  
Wrist Fracture ◽  
Full Recovery ◽  
Standardized Assessments ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Increased Risk ◽  
And Function

AbstractBackground and aimsPain-related fear and catastrophizing are prominently related to acute and persistent back pain, but little is known about their role in pain and function after a fracture. Since fractures have a clear etiology and time point they are of special interest for studying the process of recovery. Moreover, fracture injuries are interesting in their own right since patients frequently do not recover fully from them and relatively little is known about the psychological aspects. We speculated that catastrophizing and fear-avoidance beliefs might be associated with more pain and poorer recovery after an acute, painful fracture injury.MethodsTo this end we conducted a prospective cohort study recruiting 70 patients with fractures of the wrist or the ankle. Participants completed standardized assessments of fear, pain, catastrophizing, degree of self-rated recovery, mobility and strength within 24 h of injury, and at 3- and 9-month follow-ups. Participants were also categorized as having high or low levels of fear-avoidance beliefs by comparing their scores on the first two assessments with the median from the general population. To consolidate the data the categorizations from the two assessments were combined and patients could therefore have consistently high, consistently low, increasing, or decreasing levels.ResultsResults indicated that levels of fear-avoidance beliefs and catastrophizing were fairly low on average. At the first assessment 69% of the patients expected a full recovery within 6 months, but in fact only 29% were fully recovered at the 9-month follow-up. Similarly, comparisons between the affected and non-affected limb showed that 71% of those with a wrist fracture and 58% with an ankle fracture were not fully recovered on grip strength and heel-rise measures. Those classified as having consistently high or increasing levels of fear-avoidance beliefs had a substantially increased risk of more intense future pain (adjusted OR = 3.21). Moreover, those classified as having consistently high or increasing levels of catastrophizing had an increased risk for a less than full recovery of strength by almost six-fold (adjusted OR = 5.87).Conclusions and implications This is the first investigation to our knowledge where the results clearly suggest that fear and catastrophizing, especially when the level increases, may be important determinants of recovery after an acute, painful, fracture injury. These results support the fear-avoidance model and suggest that psychological factors need to be considered in the recovery process after a fracture.

scholarly journals Influence of Fear-Avoidance Beliefs on Disability in Patients With Subacromial Shoulder Pain in Primary Care: A Secondary Analysis

2014 ◽  
Vol 94 (12) ◽  
pp. 1775-1784 ◽  
Author(s):  
Thilo O. Kromer ◽  
Judith M. Sieben ◽  
Rob A. de Bie ◽  
Caroline H.G. Bastiaenen
Keyword(s):  
Shoulder Pain ◽  
Pain Syndrome ◽  
Regression Analyses ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Change Scores ◽  
Subacromial Pain Syndrome ◽  
Fear Avoidance Model

Background Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome. Objective The purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up. Design A cross-sectional and longitudinal analysis was conducted. Methods Baseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fear-avoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses. Results Correlations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months. Limitations Patients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group. Conclusions Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.

scholarly journals The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

2021 ◽  
Vol 11 (1) ◽  
pp. 154
Author(s):  
Mercè Balasch-Bernat ◽  
Lirios Dueñas ◽  
Marta Aguilar-Rodríguez ◽  
Deborah Falla ◽  
Alessandro Schneebeli ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Central Sensitization ◽  
Clinical Symptoms ◽  
Pain Catastrophizing ◽  
Frozen Shoulder ◽  
Spatial Extent ◽  
Pain Sensitization ◽  
Psychological Features ◽  
Painful Area ◽  
Pain Extent

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.

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