Effect of Neural Therapy on shoulder dysfunction and pain in supraspinatus tendinopathy

Objectives: To investigate the effect of 1% procaine injection, which is used in neural therapy, on shoulder pain and dysfunction in patients diagnosed with supraspinatus tendinopathy. Methods: The Range of Motion values, Visual Analog Scale and the QuickDASH Scale scores of 70 patients, who were diagnosed with musculus supraspinatus tendinitis based on magnetic resonance imaging findings, were analyzed. The data of the scales obtained before neural therapy and at the follow-up visit at four weeks after the end of therapy were compared, and a p-value of <0.05 was considered statistically significant. Results: After neural therapy, a statistically significant increase was observed in Range of Motion values and there was a statistically significant decrease in both the Visual Analog Scale and QuickDASH score averages. Conclusion: This is one of the rare studies showing the effects of neural therapy application on shoulder pain severity and dysfunction in patients with supraspinatus tendinitis who are resistant to medical therapy. doi: https://doi.org/10.12669/pjms.38.3.4823 How to cite this:Bashan I, Ozturk GY. Effect of Neural Therapy on shoulder dysfunction and pain in supraspinatus tendinopathy. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4823 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Non-Operative Shoulder Dysfunction in the United States Military

ABSTRACT Introduction Recent epidemiological evidence shows that shoulder and upper-arm complaints impose a substantial burden on the armed forces of the United States and create significant challenges for all components of the physical fitness domain of total force fitness. Clinicians, epidemiologists, and health-services researchers interested in shoulder and upper-arm injuries and their functional limitations rarely have objective, validated criteria for rigorously evaluating diagnostic practices, prescribed treatments, or the outcomes of alternative approaches. We sought to establish and quantify patient volume, types of care, and costs within the Military Health System (MHS) in assessing and managing active duty members with nonoperative shoulder and upper-arm dysfunction. Materials and Methods We performed a retrospective cohort study using data from the MHS Data Repository and MHS MART (M2) from fiscal year 2014 to identify active duty individuals with a diagnosis of shoulder and upper-arm injury or impairment defined by one of the International Classification of Disease Ninth Edition diagnosis codes that were selected to reflect nonoperative conditions such as fractures or infections. Statistical analyses include descriptive statistics on patient demographics and clinical visits, such as the range and frequency of diagnoses, number and types of appointments, and clinical procedure information following the diagnosis. We also examined treatment costs related to shoulder dysfunction and calculated the total cost to include medications, radiological, procedural, and laboratory test costs for all shoulder dysfunction visits in 2014 and the average cost for each visit. We further examined the category of each medication prescribed. Results A total of 55,643 individuals met study criteria and accrued 193,455 shoulder-dysfunction-related clinical visits in fiscal year 2014. This cohort represents approximately 4.8% of the 1,155,183 active duty service members assigned to the United States and its territories during FY 2014. Most patients were male (85.32%), younger (85.25% were under 40 years old), and Caucasian/White (71.12%). The most common diagnosis code was 719.41 (pain in joint, shoulder region; 42.48%). The majority of the patients 42,750 (76.8%) had four or fewer medical visits during the study period and 12,893 (23.2%) had more than four visits. A total of 4,733 patients (8.5%) underwent arthrocentesis aspiration or injection. The total cost for all visits was $65,066,767.89. The average and median cost for each visit were $336.34 (standard deviation was $1,493.87) and $163.11 (range was from 0 to $84,183.88), respectively. Three out of four patients (75.3%) underwent radiological examinations, and 74.2% of these individuals had more than one radiological examination. Medications were prescribed to 50,610 (91.0%) patients with the three most common being IBUPROFEN (12.21%), NAPROXEN (8.51%), and OXYCODONE-ACETAMINOPHEN (5.04%), respectively. Conclusions Nearly 1 in 20 active duty military service members presented for nonoperative care of shoulder and/or upper-arm dysfunction during FY2014. Further examinations of the etiology and potential impact of shoulder/upper-arm dysfunction on force readiness are clearly warranted, as are additional studies directed at identifying best practices for preventing injury-related dysfunction and determining best practices for the treatment of shoulder dysfunction to optimize service member fitness and force readiness.

Association of Shoulder Dysfunction with Mobility Limitation in Older Adults of the BLSA

Mobility limitation affects one-third of older adults; yet, the impact of shoulder dysfunction which effects roughly 20%, is inadequately documented. As arm swing is a fundamental component of ambulation, we investigated the cross-sectional association between shoulder range of motion (ROM) and walking endurance using time to walk 400m as quickly as possible and lower extremity performance using the expanded Short Physical Performance Battery (e-SPPB). Data are from 614 men (50.5%) and women aged ≥ 60 years (mean 71.8 ±8 years) in the Baltimore Longitudinal Study of Aging (BLSA) who performed bilateral shoulder elevation and/or bilateral shoulder external rotation (ER) during nurse-administered physical examination. We examined odds of poor 400m-walk and e-SPPB performance defined as the worst quartile associated with abnormal shoulder elevation (≤9%) relative to bilateral normal shoulder elevation and abnormal shoulder external rotation (≤5%) relative to bilateral normal shoulder external rotation (ER) in separate analyses. Analyses were adjusted for age, sex, weight and height. Adjusted odds (95% confidence interval) of poor 400m-walk performance associated with abnormal shoulder elevation (N=254) were 4.7 (1.1-19.5;p=0.035) and with abnormal shoulder ER (n=401) were 4.8 (1.4-16.7;p=0.010). Adjusted odds of poor e-SPPB performance associated with abnormal shoulder elevation (N=462) were 3.5 (1.6-7.7;p=0.002) and with abnormal shoulder ER (n=457) were 2.9 (1.1-7.4;p=0.030). Results suggest abnormal shoulder ROM is associated with poorer walking endurance capacity and lower-extremity functional performance in the relatively healthy older adults. Future research is warranted to develop novel screening paradigms that mitigate mobility limitation and functional decline in older adults with shoulder dysfunction.

Validation of the Korean Version of the Neck Dissection Impairment Index in Patients Who Underwent Neck Dissection

Background/Objectives: Shoulder function is an important aspect of health related quality of life (QOL). Neck dissection impairment index (NDII) is a simple shoulder-specific questionnaire. This study aimed to evaluate the association between QOL and NDII in patients who underwent neck dissection to validate the Korean version of NDII.Materials & Methods: This study enrolled 74 patients with head and neck cancer who underwent neck dissection from December 2013 to April 2014. Patients completed questionnaires on QOL including the European Organization of Research and Treatment of Cancer 30-item Core QOL questionnaire (EORTC QLQ-C30) and NDII which was translated into Korean. Validity was evaluated by calculating the Pearson correlation coefficient between NDII and EORTC QLQ-C30.Results: We compared preoperative, postoperative within a week, 1st and 3rd months NDII scores. The total NDII scores were 14.7, 47.4, 33.7 and 34.3 each. Clinical variables including gender, site of primary tumor, performing revision neck dissection, radiotherapy and flap reconstruction were not significantly associated with NDII. However NDII mean score of patients who underwent unilateral neck dissection over 3 levels is most increased after operation. During all periods NDII scores were significantly associated with functioning score. Although other scores are lower correlation than function scores, global health status scores and symptom scores are also correlation with NDII.Conclusion: NDII was valid instrument and can be used not only in the clinical practice to assess shoulder dysfunction but also in the simple instrument to evaluate global QOL in Korea patients with having neck dissection.

Reversed shoulder arthroplasty in treatment of proximal humeral fractures – early results in Department of Orthopaedics, Traumatology and Oncology, Regional Hospital in Torun, Poland

Introduction. Proximal humeral fractures (PHF) are a frequent finding, and still growing part of it needs to be treated operatively. Extending life expectancy, increasing percentage of osteoporotic fractures and progressive patients’ demand force surgeons to seek the best solutions of treating complex fractures. Just some teen years ago older patients who suffered a severe PHF were doomed to shoulder dysfunction. Today we can offer them a reversed shoulder arthroplasty (RSA) Purpose. The aim of the paper was a clinical evaluation of the patients who were treated with RSA in a Regional Hospital. Material and Methods. In years 2017-2021 in our department there were performed 41 RSAs and 5 TSAa (total anatomic shoulder arthroplasty). Earlier in 2010-2017 we performed 26 hemiarthroplasties. The procedures were done via delto-pectoral approach. The implant used were Aequalis Reversed Fracture (Tornier) and SMR (Lima). Results. The patients were evaluated in a simplified manner after 6 months postop. Functional active range of motion and VAS score were noted. Conclusions. In our department RSA is a well adopted method of treating complex PHFs, especially in elderly patients, and it yields overall good results and great percentage of satisfied patients.

Comprehensive rehabilitation of Supraspinatus tear: A case study of post-op fracture stiffness

The disorders of the upper extremity and the shoulder is extremely common accounting for 30 % of people who experience shoulder pain and stiffness at some stage of their ageing. A high incidence of shoulder dysfunction is seen in people in recent trends. Shoulder stiffness is the main complication after fracture shoulder immobilization, and Diabetes Mellitus contribute to the frozen shoulder, which is the most typical complication in Diabetes mellitus patients. A case of lateral clavicle fracture with chief complaints of pain on the right shoulder, stiffness around the joint and reduced range of motion was reported to the outpatient physiotherapy department for rehabilitation. A proper assessment was done, and the differential diagnosis was frozen shoulder with supraspinatus tendon tear was reported. The patient also had a reduced range of motion of shoulder abduction and lateral rotation due to frozen shoulder. The investigation of MRI report stated that there is a partial supraspinatus tendon tear. Medical examination of the frozen shoulder confirms the diagnosis. A combination of non-pharmacological treatment with exercises, NSAID and exercise therapy, was planned. He was successfully treated with the combination of physical therapy treatment with the electrotherapy modalities and shoulder girdle mobilization. Comprehensive therapeutic exercises include mobilization of soft tissue using Cyriax technique, peripheral joint mobilization to improve controlled ROM. Mobilization of soft tissue along with home exercise supports patients suffering from frozen shoulder. The treatment primarily aimed at relieving pain and increasing range of motion and thus improving the quality of life in the patient. Only manual therapy alone does not give satisfactory results along with electrotherapeutic modality with proper dose work on the patient.