Regaining motion among patients with shoulder pathology - are all exercises equal?

Background Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Conclusions Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM.

Practicability of a Virtual Consultation to Evaluate the Shoulder Joint

Objective In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. Methods Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. Results 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 – 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. Conclusion Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.

Validation of Fatigue Failure Risk Assessment Tools Against Physician-Diagnosed Outcomes

Evidence suggests that musculoskeletal disorders (MSDs) may be the result of a fatigue failure process in musculoskeletal tissues. Recently risk assessment tools using fatigue failure principles have been developed to evaluate risk of low back disorders (LiFFT), distal upper extremity disorders (DUET), and shoulder disorders (The Shoulder Tool). All have been validated against multiple musculoskeletal disorder outcomes such as joint pain and clinic visits for MSD complaints. This paper provides validation of DUET against occupational physician diagnosed carpal tunnel syndrome (CTS) and The Shoulder Tool against diagnosed bicipital tendinosis. Results demonstrated that in both cases the fatigue failure risk assessment tools were significantly associated with physician-diagnosed outcomes in both crude and adjusted analyses (p < 0.01).

Work-related and personal factors in shoulder disorders among electronics workers: findings from an electronics enterprise in Taiwan

Background The electronics industry is one of the largest global industries, and significant numbers of workers are engaged in this industry. Evidence suggests two associations, including one between ergonomic risks and shoulder disorders and another between psychological stress and psychological problems among workers in this industry. Investigations on ergonomic risks, psychological stress, and sex effects for shoulder disorders in this industry are limited. This study aimed to explore personal and work-related factors associated with shoulder disorders and to investigate the combined effect of similar ergonomic risk factors. Methods In this cross-sectional study, 931 workers aged 20 to 58 from an electronics factory in Taiwan were recruited. A Nordic musculoskeletal questionnaire was used to assess shoulder symptoms. Sociodemographic factors and work-related factors, including psychological stress, were assessed. One hundred random sample workers with shoulder symptoms underwent a standardized clinical test for the evaluation of subacromial impingement syndrome. The ergonomic risks were assessed by the risk filter of ‘upper limb disorders in the workplace’, including repetition, posture, force, vibration, and duration of exposure. Results The prevalence of shoulder symptoms was 30.5, and 19% of those with shoulder symptoms had subacromial impingement syndrome. In multivariable analyses, older age (adjusted odds ratio (aOR) = 1.37, 95% CI 1.01–1.86), repetition (aOR = 1.73, 95% CI 1.15–2.60) and posture (aOR = 1.85, 95% CI 1.10–3.11) were associated with shoulder symptoms. Regarding the gender effect, older age (aOR = 1.46, 95% CI 1.01–2.11), repetition (aOR = 1.64, 95% CI 1.00–2.68), posture (aOR = 1.89, 95% CI 1.01–3.52), and force (aOR = 1.68, 95% CI 0.99–2.85) were associated with shoulder symptoms in men, whereas posture (aOR = 2.12, 95% CI 0.99–4.57) was associated with symptoms in women. Conclusions This study implies that repetition and posture are important risk factors for shoulder disorders in the electronics industry. The risk exhibited sex differences, and force was more important for shoulder disorders in men. Such information is useful to help occupational health practitioners and policy makers conduct preventive programmes on shoulder disorders in this working population. Future longitudinal studies on work-related shoulder disorders are warranted.

Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review

Background Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention. Methods This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against. Results Of 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome. Conclusions Five constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.

Red flags useful to screen for gastrointestinal and hepatic diseases in patients with shoulder pain: a scoping review protocol

Shoulder pain (SP) is the third most common musculoskeletal disorder worldwide and its prevalence ranges from 5 to 47%. However, the clinical presentation of signs and symptoms may hide other serious conditions; the so-called Red Flags (RFs). For these reasons, clinicians dealing with neuro-musculoskeletal shoulder disorders should pay particular attention during the medical history and clinical examination screening and identifying signs that may cause probable referred symptoms. Considering the variety of clinical presentations of SP and the importance of the screening for referral, identifying and summarizing the possible gastrointestinal and hepatic diseases among these patients may give a comprehensive overview to the clinicians and consequently may improve the overall management. To the authors knowledge, there are no published studies on the topic and, in this context, a scoping review is strongly required and corresponded to the objectives of this project.

Inter-professional agreement and collaboration between extended scope physiotherapists and orthopaedic surgeons in an orthopaedic outpatient shoulder clinic – a mixed methods study

Background Extended scope physiotherapists (ESP) are increasingly supplementing orthopaedic surgeons (OS) in diagnosing patients with musculoskeletal disorders. Studies have reported satisfactory diagnostic and treatment agreement between ESPs and OSs, but methodological study quality is generally low, and only few studies have evaluated inter-professional collaboration. Our aims were: 1) to evaluate agreement on diagnosis and treatment plan between ESPs and OSs examining patients with shoulder disorders, 2) to explore and evaluate their inter-professional collaboration. Methods In an orthopaedic outpatient shoulder clinic, 69 patients were examined independently twice on the same day by an ESP and an OS in random order. Primary and secondary diagnoses (nine categories) and treatment plan (five categories, combinations allowed) were registered by each professional and compared. Percentage of agreement and kappa-values were calculated. Two semi-structured focus-group interviews were performed with ESPs and OSs, respectively. Interviews were based on the theoretical concept of Relational Coordination, encompassing seven dimensions of communication and relationship among professionals. A thematic analysis was conducted. Results Agreement on primary diagnosis was 62% (95% CI: [50; 73]). ESPs and OSs agreed on the combination of diagnoses in 79% (95% CI: [70; 89]) of the cases. Partial diagnostic agreement (one professional’s primary diagnosis was also registered as either primary or secondary diagnosis by the other) was 96% (95% CI: [91; 100]). Across treatment categories, agreement varied between 68% (95% CI: [57; 79]) and 100%. In 43% (95% CI: [31; 54]) of the cases, ESP and OS had full concordance between treatment categories chosen, while they agreed on at least one recommendation in 96% (95% CI: [91; 100]). Positive statements of all dimensions of relational coordination were found. Three themes especially important in the inter-professional collaboration emerged: Close communication, equal and respectful relationship and professional skills. Conclusions In the majority of cases, the ESP and OS registered the same or partly the same diagnosis and treatment plan. Indications of a high relational coordination implying a good inter-professional collaboration were found. Our results support that ESPs and OSs can share the task of examining selected patients with shoulder disorders in an orthopaedic clinic. Trial registration ClinicalTrials.gov Identifier: NCT03343951. Registered 10 November 2017