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Pre-emptive ketorolac for prevention of intraoperative shoulder pain in patients undergoing cesarean section: A double blind randomized clinical trial.
Abbas, MS, Askar, OA, Abdel Aleem, AA
Asian journal of anesthesiology. 2017;(3):68-72
Abstract
BACKGROUND Shoulder pain is a commonly observed but mostly neglected consequence of cesarean section and little is known as well as explored about intraoperative shoulder pain. We conducted this randomized prospective double-blinded study to evaluate the efficacy of ketorolac in reducing the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section. METHODS Two hundred ASA I and II patients scheduled to undergo elective cesarean section under spinal anesthesia were randomized to receive either intravenous ketorolac 30 mg (ketorolac group) or normal saline (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were severity of intraoperative shoulder pain, amount of intraoperative blood loss, incidence of hypotension, bradycardia and request for intraoperative rescue analgesia. RESULTS The incidence of intraoperative shoulder pain in the control group was significantly higher than the ketorolac group (P = 0.003). Severity of shoulder pain and requests for intraoperative analgesia was significantly higher in the control group (P = 0.012, P = 0.006 respectively). Patients in the Ketorolac group experienced significantly higher incidences of bradycardia (P = 0.037). CONCLUSION 30 mg ketorolac administered intravenously just before the operation could decrease incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section. CLINICAL TRIAL REGISTRATION ClinicalTrial.gov (Registration number: NCT02380898, first registered in 01/03/2015).
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2.
[Case control study on ultrasound guided microtraumatic treatment of acute subacromial bursitis].
Duan, H, Pu, D, Chen, SY
Zhongguo gu shang = China journal of orthopaedics and traumatology. 2016;(9):800-803
Abstract
OBJECTIVE To evaluate the efficacy of ultrasound guided microtraumatic treatment of acute subacromial bursitis. METHODS The patients with shoulder pain from June 2012 to March 2014 were treated with musculoskeletal bone ultrasound examination. A total of 120 patients were diagnosed with acute subacromial bursitis, who were randomized divided into two groups:US guided injection group(ultrasound group) and palpation guided injection group(closed group). The patients in each group were injected with a mixture of 3.5 ml Betamethasone compound lidocaine mixture and 2.5 ml Sodium hyaluronate into the subacromial bursa. The outcome measures were the visual analog scale(VAS) for analyzing pain degree, the night rest pain and Constant-Murley score for detecting shoulder function, rate of secondary injection, and comprehensive effect. The VAS, the night rest pain and CMS were evaluated before, 1 day, 1 week, and 1 month after the injection. RESULTS After treatment, the shoulder pain and function were improved. One day and 1 week after the injection, the VAS between the two groups were compared. The pain improvement in ultrasonic group was better than in the traditional group, and the difference was statistically significant(P<0.05). In the two groups, the night rest pain was relieved after treatment, and 1 day after the injection, the night rest pain in the ultrasonic group was significantly lower than that in the traditional group(P<0.05). One day, 1 week and 1 mouth after the injection, the CMS between the two groups were compared, and the improvement of CMS in the ultrasonic group was significantly better than that in the traditional group(P<0.05). The patient number with secondary injection in the ultrasonic group was 13 cases, which was significantly less than that in the closed group 45 cases(P<0.05). The recovery number of ultrasonic group was significantly better than that of the traditional group(P<0.05). CONCLUSIONS The ultrasound guided microtraumatic treatment of acute subacromial bursitis worked faster than traditional closed therapy. The short term curative effect and the comprehensive curative effect is better than the traditional closed treatment. The US guided subacromial injection technique is effective in guiding the needle into the subacromial bursa in patients with acute subacromial bursitis.
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3.
Electrotherapy modalities for rotator cuff disease.
Page, MJ, Green, S, Mrocki, MA, Surace, SJ, Deitch, J, McBain, B, Lyttle, N, Buchbinder, R
The Cochrane database of systematic reviews. 2016;(6):CD012225
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Abstract
BACKGROUND Management of rotator cuff disease may include use of electrotherapy modalities (also known as electrophysical agents), which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, or thermal) into the body. Examples include therapeutic ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), and pulsed electromagnetic field therapy (PEMF). These modalities are usually delivered as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. OBJECTIVES To synthesise available evidence regarding the benefits and harms of electrotherapy modalities for the treatment of people with rotator cuff disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCOhost, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-randomised trials, including adults with rotator cuff disease (e.g. subacromial impingement syndrome, rotator cuff tendinitis, calcific tendinitis), and comparing any electrotherapy modality with placebo, no intervention, a different electrotherapy modality or any other intervention (e.g. glucocorticoid injection). Trials investigating whether electrotherapy modalities were more effective than placebo or no treatment, or were an effective addition to another physical therapy intervention (e.g. manual therapy or exercise) were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. MAIN RESULTS We included 47 trials (2388 participants). Most trials (n = 43) included participants with rotator cuff disease without calcification (four trials included people with calcific tendinitis). Sixteen (34%) trials investigated the effect of an electrotherapy modality delivered in isolation. Only 23% were rated at low risk of allocation bias, and 49% were rated at low risk of both performance and detection bias (for self-reported outcomes). The trials were heterogeneous in terms of population, intervention and comparator, so none of the data could be combined in a meta-analysis.In one trial (61 participants; low quality evidence), pulsed therapeutic ultrasound (three to five times a week for six weeks) was compared with placebo (inactive ultrasound therapy) for calcific tendinitis. At six weeks, the mean reduction in overall pain with placebo was -6.3 points on a 52-point scale, and -14.9 points with ultrasound (MD -8.60 points, 95% CI -13.48 to -3.72 points; absolute risk difference 17%, 7% to 26% more). Mean improvement in function with placebo was 3.7 points on a 100-point scale, and 17.8 points with ultrasound (mean difference (MD) 14.10 points, 95% confidence interval (CI) 5.39 to 22.81 points; absolute risk difference 14%, 5% to 23% more). Ninety-one per cent (29/32) of participants reported treatment success with ultrasound compared with 52% (15/29) of participants receiving placebo (risk ratio (RR) 1.75, 95% CI 1.21 to 2.53; absolute risk difference 39%, 18% to 60% more). Mean improvement in quality of life with placebo was 0.40 points on a 10-point scale, and 2.60 points with ultrasound (MD 2.20 points, 95% CI 0.91 points to 3.49 points; absolute risk difference 22%, 9% to 35% more). Between-group differences were not important at nine months. No participant reported adverse events.Therapeutic ultrasound produced no clinically important additional benefits when combined with other physical therapy interventions (eight clinically heterogeneous trials, low quality evidence). We are uncertain whether there are differences in patient-important outcomes between ultrasound and other active interventions (manual therapy, acupuncture, glucocorticoid injection, glucocorticoid injection plus oral tolmetin sodium, or exercise) because the quality of evidence is very low. Two placebo-controlled trials reported results favouring LLLT up to three weeks (low quality evidence), however combining LLLT with other physical therapy interventions produced few additional benefits (10 clinically heterogeneous trials, low quality evidence). We are uncertain whether transcutaneous electrical nerve stimulation (TENS) is more or less effective than glucocorticoid injection with respect to pain, function, global treatment success and active range of motion because of the very low quality evidence from a single trial. In other single, small trials, no clinically important benefits of pulsed electromagnetic field therapy (PEMF), microcurrent electrical stimulation (MENS), acetic acid iontophoresis and microwave diathermy were observed (low or very low quality evidence).No adverse events of therapeutic ultrasound, LLLT, TENS or microwave diathermy were reported by any participants. Adverse events were not measured in any trials investigating the effects of PEMF, MENS or acetic acid iontophoresis. AUTHORS' CONCLUSIONS Based on low quality evidence, therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease. Further high quality placebo-controlled trials are needed to confirm these results. In contrast, based on low quality evidence, PEMF may not provide clinically relevant benefits over placebo, and therapeutic ultrasound, LLLT and PEMF may not provide additional benefits when combined with other physical therapy interventions. We are uncertain whether TENS is superior to placebo, and whether any electrotherapy modality provides benefits over other active interventions (e.g. glucocorticoid injection) because of the very low quality of the evidence. Practitioners should communicate the uncertainty of these effects and consider other approaches or combinations of treatment. Further trials of electrotherapy modalities for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.
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Suprathreshold heat pain response predicts activity-related pain, but not rest-related pain, in an exercise-induced injury model.
Coronado, RA, Simon, CB, Valencia, C, Parr, JJ, Borsa, PA, George, SZ
PloS one. 2014;(9):e108699
Abstract
Exercise-induced injury models are advantageous for studying pain since the onset of pain is controlled and both pre-injury and post-injury factors can be utilized as explanatory variables or predictors. In these studies, rest-related pain is often considered the primary dependent variable or outcome, as opposed to a measure of activity-related pain. Additionally, few studies include pain sensitivity measures as predictors. In this study, we examined the influence of pre-injury and post-injury factors, including pain sensitivity, for induced rest and activity-related pain following exercise induced muscle injury. The overall goal of this investigation was to determine if there were convergent or divergent predictors of rest and activity-related pain. One hundred forty-three participants provided demographic, psychological, and pain sensitivity information and underwent a standard fatigue trial of resistance exercise to induce injury of the dominant shoulder. Pain at rest and during active and resisted shoulder motion were measured at 48- and 96-hours post-injury. Separate hierarchical models were generated for assessing the influence of pre-injury and post-injury factors on 48- and 96-hour rest-related and activity-related pain. Overall, we did not find a universal predictor of pain across all models. However, pre-injury and post-injury suprathreshold heat pain response (SHPR), a pain sensitivity measure, was a consistent predictor of activity-related pain, even after controlling for known psychological factors. These results suggest there is differential prediction of pain. A measure of pain sensitivity such as SHPR appears more influential for activity-related pain, but not rest-related pain, and may reflect different underlying processes involved during pain appraisal.
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Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels.
Ioppolo, F, Tattoli, M, Di Sante, L, Attanasi, C, Venditto, T, Servidio, M, Cacchio, A, Santilli, V
Physical therapy. 2012;(11):1376-85
Abstract
BACKGROUND Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses. OBJECTIVE The aim of this study was to compare 2 different ranges of energy flux density in treatment of SCT with ESWT. DESIGN This study was designed as a single-blind randomized clinical trial. SETTING This study was performed in a university hospital. PATIENTS Forty-six patients with SCT were randomly assigned to 2 groups that received different therapeutic energy doses of ESWT (1) group A received ESWT at an energy level of 0.20 mJ/mm², and (2) group B received ESWT at an energy level of 0.10 mJ/mm². INTERVENTION The treatment protocol consisted of 4 sessions performed once a week. MEASUREMENTS The change in mean Constant Murley Scale (CMS) scores at 3 and 6 months was the primary endpoint. The change in the mean visual analog scale (VAS) scores from baseline to 3 and 6 months after the intervention and radiographic change in size of calcium deposits were evaluated as secondary endpoints. At 12 months, pain relief was assessed using a numeric rating scale. RESULTS Significant clinical improvement based on mean CMS scores was observed after 6 months in group A (X=79.43, SD=10.33) compared with group B (X=57.91, SD=6.53). Likewise, after 6 months, a significant decrease in VAS scores was found in group A (X=2.09, SD=1.54) compared with group B (X=5.36, SD=0.78). Calcific deposits disappeared in the same percentage of patients in both groups. LIMITATIONS The small sample size and lack of a control group were limitations of the study. CONCLUSIONS In ESWT for SCT, an energy level of 0.20 mJ/mm² appears to be more effective than an energy level of 0.10 mJ/mm² in pain relief and functional improvement.
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[Clinical observation on "Jianying point"-injection combined with massage for treatment of periarthritis of shoulder].
Liao, BN, Zhang, S, Zhang, LM
Zhongguo zhen jiu = Chinese acupuncture & moxibustion. 2007;(4):261-3
Abstract
OBJECTIVE To search for a clinically effective therapy for periarthritis of shoulder. METHODS One hundred and forty cases were randomly divided into a treatment group and a control group, 70 cases in each group. The treatment group were treated with "Jianying point" -injection combined with massage, and the control group with routine acupuncture therapy. The pain scores and the comprehensive scores of motor function before and after treatment in the two groups were compared between the two groups. RESULTS The different value of the pain scores before and after treatment was 31.54+/-2.82 in the treatment group and 15.03+/-4.07 in the control group, with a very significant difference between the two groups (P<0.01); after treatment, the comprehensive score of motor function of the shoulder joint was 139.64+/-12.34 in the treatment group and 80.32+/-16.29 in the control group, with a very significant difference between the two groups (P<0.01). CONCLUSION "Jiunying point" -injection combined with massage has clinically an obvious effect on periarthritis of shoulder.
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Epidemiology of chronic musculoskeletal pain.
McBeth, J, Jones, K
Best practice & research. Clinical rheumatology. 2007;(3):403-25
Abstract
The rate of musculoskeletal pain in adolescent and adult populations is examined, with a focus on three commonly reported pain disorders: shoulder pain, low back pain and fibromyalgia/chronic widespread pain. There is a paucity of data on musculoskeletal pain in adolescent populations. Those studies available suggest that pain is common, although the actual rates are unclear. This is probably due to differences in study methodologies and populations. Pain is commonly reported among adult populations, with almost one fifth reporting widespread pain, one third shoulder pain, and up to one half reporting low back pain in a 1-month period. The prevalence of pain varies within specific population subgroups; group factors (including socioeconomic status, ethnicity and race) and individual factors (smoking, diet, and psychological status) are all associated with the reporting of musculoskeletal pain. However, the precise nature of these relationships, and particularly the mechanisms of association, are unclear and require further investigation.
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An overview of treatment options for persistent shoulder pain.
Moskowitz, RW, Blaine, TA
American journal of orthopedics (Belle Mead, N.J.). 2005;(12 Suppl):10-5
Abstract
Persistent shoulder pain (PSP) associated with rotator cuff disorders, glenohumeral osteoarthritis (OA), or adhesive capsulitis is a very common, often difficult-to-treat condition. The first step in nonoperative therapy for PSP in most patients is physical therapy, rest, and use of various heat modalities. Relief of pain from exercises aimed at improving strength and range of motion may be enhanced by administration of oral analgesics. Oral nonsteroidal anti-inflammatory drugs are often prescribed for patients with PSP, but their use may be complicated by gastrointestinal side effects and a potential for increased risk for serious cardiovascular events. Intra-articular corticosteroid injections have been demonstrated to provide benefit in patients with rotator cuff disorders and perhaps also in those with adhesive capsulitis. Results from both small-scale studies and a recent large-scale trial have shown that injection of sodium hyaluronate is also effective for the treatment of PSP, particularly in patients with glenohumeral OA. Additional well-controlled comparative trials are needed to define which treatment modalities are likely to be most effective in subsets of patients with PSP.
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Shoulder joint capsule distension (hydroplasty): a case series of patients with "frozen shoulders" treated in a primary care office.
Halverson, L, Maas, R
The Journal of family practice. 2002;(1):61-3
Abstract
"Frozen shoulder," most often caused by adhesive capsulitis, is frequently treated with intra-articular steroid injections, physical therapy, and surgical manipulation under anesthesia. These therapies provide limited benefits. Hydraulic distension of the shoulder joint capsule (hydroplasty) has potential to provide rapid relief of pain and immediate improvement of shoulder function for patients with adhesive capsulitis. We performed 21 hydroplasty procedures on 16 patients over a 4-year period. Ninety-four percent (17/18) of the procedures improved patient's measured mobility immediately after the procedure. Fifty-three percent (10/19) of the procedures produced immediate, short term, and sustained improvement in comfort and function. No significant complications of the procedure were detected. Our series suggests that the hydroplasty procedure should be further evalutated.