Shockwave therapy associated with progressive exercises in rotator cuff tendinopathy: a clinical trial protocol

2021 ◽  
Author(s):  
Athilas Braga de Menezes ◽  
Rodrigo Scattone Silva ◽  
Juliana Franco Adala ◽  
Renata Michelini Guidi ◽  
Richard Eloin Liebano
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Rating Scale ◽  
Exercise Program ◽  
Score Function ◽  
Shockwave Therapy ◽  
Patient Reported ◽  
Progressive Exercise ◽  
And Function ◽  
Rotator Cuff Tendinopathy

The aim of the present study is to determine whether adding shockwave therapy (SWT) to a progressive exercise program improves shoulder pain and function in individuals with rotator cuff tendinopathy (RC tendinopathy). Ninety patients diagnosed with rotator cuff tendinopathy will be randomly allocated into two groups: active SWT plus a progressive exercise program or placebo SWT plus a progressive exercise program. Primary outcomes will be measured using the Constant–Murley Score function questionnaire and by assessing patient-reported pain intensity with the numerical pain rating scale. The secondary outcomes will be measured using the Global Perceived Effects Scale and Shoulder Pain and Disability Index. All the outcomes will be measured immediately after the end of treatment and at 3-month follow-up.

Impact of patient resilience on early recovery from rotator cuff repair

2021 ◽  
pp. 175857322110035
Author(s):  
Charlie D Wilson ◽  
Benjamin D Welling ◽  
Kendall AP Hammonds ◽  
Brett N Robin
Keyword(s):  
Mental Health ◽  
Rotator Cuff ◽  
Shoulder Pain ◽  
Rotator Cuff Repair ◽  
Outcome Measurement ◽  
Physical And Mental Health ◽  
Early Recovery ◽  
Patient Reported ◽  
And Function ◽  
Cuff Repair

Aims We sought to evaluate early recovery from rotator cuff repair by assessing the correlation between patient resilience and postoperative shoulder pain and function, and physical and mental health. Methods Patients scheduled to undergo arthroscopic rotator cuff repair were prospectively enrolled. Resilience was assessed using the Brief Resilience Scale (BRS), pain and function was measured by American Society of Shoulder and Elbow Surgeons (ASES) shoulder scores, and physical and mental health was measured by the Patient-Reported Outcome Measurement Information System Global Health-10 (PROMIS-10). All scores were obtained preoperatively and postoperatively at three- and six months. Spearman correlation coefficient (r) was used to assess the relationship between variables. Results Ninety-eight patients ultimately underwent rotator cuff repair; 76 and 68 patients provided three- and six-month follow-up, respectively. There was no statistically significant correlation between preoperative BRS and three- and six-month ASES. However, there was a statistically significant correlation between preoperative BRS and three-month PROMIS-10 (r = 0.3763, p = 0.009) and concurrent BRS and PROMIS-10 at three months (r = 0.5657, p = 0.0025) and six months (r = 0.5308, p = 0.0025). Discussion Resilience appears to be more predictive of global physical and mental health than shoulder pain and function in early recovery from rotator cuff repair.

scholarly journals Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT

2021 ◽  
Vol 25 (48) ◽  
pp. 1-158
Author(s):  
Sally Hopewell ◽  
David J Keene ◽  
Peter Heine ◽  
Ioana R Marian ◽  
Melina Dritsaki ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Confidence Interval ◽  
Shoulder Pain ◽  
Best Practice ◽  
Exercise Intervention ◽  
Corticosteroid Injection ◽  
Mean Difference ◽  
Progressive Exercise ◽  
And Function

Background Rotator cuff-related shoulder pain is very common, but there is uncertainty regarding which modes of exercise delivery are optimal and the long-term benefits of corticosteroid injections. Objectives To assess the clinical effectiveness and cost-effectiveness of progressive exercise compared with best-practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. Design This was a pragmatic multicentre superiority randomised controlled trial (with a 2 × 2 factorial design). Setting Twenty NHS primary care-based musculoskeletal and related physiotherapy services. Participants Adults aged ≥ 18 years with a new episode of rotator cuff-related shoulder pain in the previous 6 months. Interventions A total of 708 participants were randomised (March 2017–May 2019) by a centralised computer-generated 1 : 1 : 1 : 1 allocation ratio to one of four interventions: (1) progressive exercise (n = 174) (six or fewer physiotherapy sessions), (2) best-practice advice (n = 174) (one physiotherapy session), (3) corticosteroid injection then progressive exercise (n = 182) (six or fewer physiotherapy sessions) or (4) corticosteroid injection then best-practice advice (n = 178) (one physiotherapy session). Main outcome measures The primary outcome was Shoulder Pain and Disability Index (SPADI) score over 12 months. Secondary outcomes included SPADI subdomains, the EuroQol 5 Dimensions, five-level version, sleep disturbance, fear avoidance, pain self-efficacy, return to activity, Global Impression of Treatment and health resource use. Outcomes were collected by postal questionnaires at 8 weeks and at 6 and 12 months. A within-trial economic evaluation was also conducted. The primary analysis was intention to treat. Results Participants had a mean age of 55.5 (standard deviation 13.1) years and 49.3% were female. The mean baseline SPADI score was 54.1 (standard deviation 18.5). Follow-up rates were 91% at 8 weeks and 87% at 6 and 12 months. There was an overall improvement in SPADI score from baseline in each group over time. Over 12 months, there was no evidence of a difference in the SPADI scores between the progressive exercise intervention and the best-practice advice intervention in shoulder pain and function (adjusted mean difference between groups over 12 months –0.66, 99% confidence interval –4.52 to 3.20). There was also no difference in SPADI scores between the progressive exercise intervention and best-practice advice intervention when analysed at the 8-week and 6- and 12-month time points. Injection resulted in improvement in shoulder pain and function at 8 weeks compared with no injection (adjusted mean difference –5.64, 99% confidence interval –9.93 to –1.35), but not when analysed over 12 months (adjusted mean difference –1.11, 99% confidence interval –4.47 to 2.26), or at 6 and 12 months. There were no serious adverse events. In the base-case analysis, adding injection to best-practice advice gained 0.021 quality-adjusted life-years (p = 0.184) and increased the cost by £10 per participant (p = 0.747). Progressive exercise alone was £52 (p = 0.247) more expensive per participant than best-practice advice, and gained 0.019 QALYs (p = 0.220). At a ceiling ratio of £20,000 per quality-adjusted life-year, injection plus best-practice advice had a 54.93% probability of being the most cost-effective treatment. Limitations Participants and physiotherapists were not blinded to group allocation. Twelve-month follow-up may be insufficient for identifying all safety concerns. Conclusions Progressive exercise was not superior to a best-practice advice session with a physiotherapist. Subacromial corticosteroid injection improved shoulder pain and function, but provided only modest short-term benefit. Best-practice advice in combination with corticosteroid injection was expected to be most cost-effective, although there was substantial uncertainty. Future work Longer-term follow-up, including any serious adverse effects of corticosteroid injection. Trial registration Current Controlled Trials ISRCTN16539266 and EudraCT 2016-002991-28. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 48. See the NIHR Journals Library website for further project information.

scholarly journals Ultrasound-Guided Prolotherapy with Polydeoxyribonucleotide for Painful Rotator Cuff Tendinopathy

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Kyoungho Ryu ◽  
Dongchan Ko ◽  
Goeun Lim ◽  
Eugene Kim ◽  
Sung Hyun Lee
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Specific Subset ◽  
End Of Treatment ◽  
Scale Scores ◽  
Pain Visual Analog Scale ◽  
Numerical Rating ◽  
Rotator Cuff Tendinopathy

Background. Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN), which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method. The records of patients with chronic rotator cuff tendinopathy (n=131) were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32) were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results. Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions. PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.

scholarly journals Ultrasonographic Evaluation of the Shoulders and Its Associations with Shoulder Pain, Age, and Swim Training in Masters Swimmers

Medicina ◽  
2020 ◽  
Vol 57 (1) ◽  
pp. 29
Author(s):  
Yuta Suzuki ◽  
Noriaki Maeda ◽  
Junpei Sasadai ◽  
Kazuki Kaneda ◽  
Taizan Shirakawa ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Structural Changes ◽  
Partial Tear ◽  
Increased Risk ◽  
High Prevalence ◽  
History Of ◽  
Long Head ◽  
Competitive Swimmers ◽  
Rotator Cuff Tendinopathy

Background and objectives: The long head of the biceps (LHB) and rotator cuff tendinopathy is the major cause of shoulder pain in competitive swimmers. The risk of tendinopathy increases with aging; however, the structural changes of LHB and rotator cuff in populations of masters swimmers have not been well examined. The purpose of this study was to investigate the prevalence of ultrasonographic abnormalities of the shoulders in masters swimmers, and the association of pain, age, and swim training with structural changes in this population. Materials and Methods: A total of 60 subjects participated in this study, with 20 masters swimmers with shoulder pain, 20 asymptomatic masters swimmers, and 20 sex- and age-matched controls. All swimmers completed a self-reported questionnaire for shoulder pain, their history of competition, and training volume. Each subject underwent ultrasonographic examination of both shoulders for pathologic findings in the LHB tendon, rotator cuff (supraspinatus (SSP) and subscapularis (SSC)) tendons, and subacromial bursa (SAB) of both shoulders and had thickness measured. Results: The prevalence of tendinosis (LHB, 48.8%; SSP, 17.5%; SSC, 15.9%), partial tear (SSP, 35.0%), and calcification (SSC, 10.0%) were higher in swimmers than in controls. LHB and SSP tendinosis were associated with shoulder pain. Older age and later start of competition were associated with an increased risk of LHB tendinosis and SSC calcification. Earlier initiation of swimming and longer history of competition were associated with an increased risk of SSP and SSC tendinosis. The thicker SSP tendon significantly increased the risk of tendinosis and partial tear. Conclusions: A high prevalence of structural changes in the rotator cuff and biceps tendons in masters swimmers reflects the effect of shoulder symptoms, aging, and swim training.

Role of Ultrasound-Guided Platelet Rich Plasma Injection in Treatment of Chronic Rotator Cuff Muscles Tendinopathy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Nassef ◽  
A E Allam ◽  
H M N Mohammed
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Platelet Rich Plasma ◽  
Clinical Manifestations ◽  
Base Line ◽  
Ultrasound Guided ◽  
Plasma Injection ◽  
Effective Treatment Modality ◽  
Rotator Cuff Tendinopathy

Abstract Background shoulder pain is the third most common musculoskeletal complaint. And rotator cuff muscles tendinopathy is one of the most common causes for shoulder pain. Aim of the Work to evaluate the effectiveness of the percutaneous ultrasound guided PRP injection in improving or treating chronic Rotator Cuff muscles tendinopathy. Patients and Methods this study was conducted on 33 patients presented to Police Hospital Nasr City and diagnosed as cases of rotator cuff tendinopathy for more than 6 months and not responding to NSAIDs. Results there is high significant improvement of the ultrasound findings and clinical manifestations of patients as regard pain, range of motion and power comparing to the base line start. According to this study, PRP was found to be more effective on the long term then short term “comparing results after one and five month”. Conclusion ultrasound guided PRP injection is a safe and an effective treatment modality for rotator cuff tendinopathy as evidenced by decreased pain and improved range of motion across the shoulder joint after the application and follow up of the PRP.

scholarly journals Effects of shockwave therapy on pain and disability in individuals with rotator cuff tendinopathy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Zhi Yin Tang ◽  
Jewel Jing Yi Wee ◽  
Hanniel Han Rong Lim
Keyword(s):  
Rotator Cuff ◽  
Shockwave Therapy ◽  
Rotator Cuff Tendinopathy

scholarly journals Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy

2019 ◽  
Vol 22 (2) ◽  
pp. 61-69
Author(s):  
Ho-Won Lee ◽  
Kyung-Ho Choi ◽  
Jung-Youn Kim ◽  
Ik Yang ◽  
Kyu-Cheol Noh
Keyword(s):  
Rotator Cuff ◽  
Conservative Treatment ◽  
Rating Scale ◽  
Platelet Rich Plasma ◽  
Constant Score ◽  
Statistical Significance ◽  
Clinical Results ◽  
Control Group ◽  
Significant Difference ◽  
Rotator Cuff Tendinopathy

Background: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP.Methods: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure.Results: There was a statistically significant difference in ΔASES<sub>3months</sub> (ASES<sub>3months</sub>-ASES<sub>first</sub>) score between the control and PRP groups (<i>p</i>=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (<i>p</i>>0.05).Conclusions: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

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