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1
Sein, Mya Lay School of Medicine UNSW. "Shoulder pain in elite swimmers." Awarded by:University of New South Wales. School of Medicine, 2006. http://handle.unsw.edu.au/1959.4/26165.
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Shoulder pain in elite swimmers is common and its cause is unknown. One hypothesis is that repetitive swimming leads to shoulder laxity, which in turn leads to impingement and shoulder pain. An observational cross-sectional study was designed to test this hypothesis. Eighty elite swimmers (13-25 years of age) completed questionnaires on their swimming training, pain and shoulder function. They were given a standardized clinical shoulder examination, and tested for inferior glenohumeral joint laxity using a noninvasive electronic laxometer designed for this study. Fifty-two swimmers also attended for a shoulder MRI. The laxometer had good-excellent reliability for inter-observer (Intra-class correlation coefficient, ICC = 0.74) and intra-observer (ICC = 0.76) assessments of joint laxity. The reliability of MRI-determined supraspinatus tendinosis was excellent with a single experienced musculoskeletal radiologist (intra-observer ICC = 0.85) and fair for an inter-observer assessment including less experienced radiologists (ICC = 0.55). MRIdetermined supraspinatus tendinosis was present in 36/52 (69%) swimmers, including four international-level athletes. A positive impingement sign correlated with supraspinatus tendinosis (r = 0.49, p = 0.0002). The impingement sign had 100% sensitivity and 65% specificity for diagnosing supraspinatus tendinopathy. Shoulder laxity correlated modestly with impingement (r = 0.23, p < 0.05). There was no association between shoulder laxity and supraspinatus tendinosis (r = 0.24, p = 0.08). The number of hours swum/week (r = 0.36, p = 0.01) and the weekly mileage (r = 0.34, p = 0.02) both correlated significantly with supraspinatus tendinopathy whereas swimming stroke preference did not. Multiple logistic regression analysis performed with supraspinatus tendinopathy as the dependent variable showed the combination of hours swum/week and weekly mileage correctly predicted tendinopathy in 85% of elite swimmers. These data indicate that: (1) supraspinatus tendinopathy is a major cause of shoulder pain in elite swimmers; and (2) this supraspinatus tendinopathy is induced by the volume/dose of swimming; and (3) shoulder laxity per se has only a minimal association with shoulder impingement in elite swimmers. These finding in humans are consistent with animal and tissue culture findings which support the hypothesis that tendinopathy is related to the dose and duration of load to tendon cells.
2
Ryan, Kelly. "The effects of manual therapy on scapular motion in a patient with shoulder impingement a dissertation [thesis] submitted in partial fulfilment for the degree of Master of Health Science, Auckland University of Technology, November 2003." Full thesis. Abstract, 2003. http://puka2.aut.ac.nz/ait/theses/RyanK.pdf.
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Jackson, Diana. "The assessment of post-stroke shoulder pain." Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.412237.
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Teys, Pamela. "The Effects of Mulligan's Mobilisation With Movement on Shoulder Pain and Dysfunction." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/366104.
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The aims of this thesis were to evaluate the immediate and long-term effects of Mobilisation-with-movement (MWM) in isolation and in conjunction with taping and therapeutic exercise for people with musculoskeletal shoulder pain. In addition, the thesis aimed to assess possible indicators of poor response to MWM to the shoulder. Shoulder pain is the third most common musculoskeletal problem with patients often experiencing persistent pain and dysfunction. For the majority, conservative treatment is initially recommended. Evidence supports the use of manual therapy (MT) as a beneficial component of a multimodal management approach but the literature describes a wide variety of MT interventions, often with poor descriptions of these interventions.
Mulligan’s MT concept involves the application of a manual glide to a joint being actively moved to the point of pain onset. Mulligan called this Mobilisation-with-movement (MWM). There is evidence in the form of randomised controlled trials (RCT) supporting the immediate success of MWM for reducing pain and improving range of movement (ROM) in peripheral joints such as the ankle and elbow. Additionally, Mulligan suggests tape to augment the immediate effects of MWM. Few high-quality trials have investigated the application of MWMs for the treatment of musculoskeletal shoulder pain. Research investigating the effects of MWM in the treatment of musculoskeletal shoulder pain will guide conservative management choices.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Allied Health
Griffith Health
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Auvinen, J. (Juha). "Neck, shoulder, and low back pain in adolescence." Doctoral thesis, University of Oulu, 2010. http://urn.fi/urn:isbn:9789514261664.
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Abstract The etiology of musculoskeletal disorders remains largely unclear, pain being the predominant complaint. The prevalence of neck pain (NP), shoulder pain (SP), and low back pain (LBP) increases drastically during adolescence. Potentially modifiable risk factors of NP, SP, and LBP should be identified at that age. First, this study evaluated the prevalence of NP, SP, LBP and peripheral pains (upper or lower extremities) and the prevalence of multiple pains. Second, the study determined the role of a set of potentially modifiable risk factors for adolescents’ NP, SP, and LBP (physical activity, inactivity, sedentary activities in cross-sectional study design and quantity and quality of sleep in follow-up study design). The study population belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), consisting of 9,479 children with an expected date of birth between July 1, 1985 and June 30, 1986 in the two northernmost provinces of Finland, Oulu and Lapland. NP, SP, and LBP were common at the ages 16 and 18, while medical consultations for these pains were less frequent. The prevalence of pain increased with age. Peripheral pains were rare. Surprisingly many adolescents reported multiple musculoskeletal pains. Girls were more likely to report pain than boys. Both low and high level of physical activity, some risk sport activities, high amount of sedentary activities, and insufficient quantity and quality of sleep increased the risk of NP, SP, and LBP in adolescence. It may be possible to reduce the occurrence of musculoskeletal pain by having a positive impact on potentially modifiable risk factors, such as physical activity, sedentary activities and sleep hygiene. Therefore, intervention studies focusing on these factors are needed in the futureTiivistelmä Useimmiten tuki- ja liikuntaelinsairauksien tarkka syy jää epäselväksi ja kipu on niiden pääasiallinen ilmentymä. Niska-, hartia- ja alaselkäkipujen esiintyvyys väestössä nousee merkittävästi teini-iässä. Tämän vuoksi niska-, hartia- ja alaselkäkivun riskitekijöitä tulisikin tutkia nuoruudessa, jotta niihin päästäisiin vaikuttamaan ajoissa. Tässä väitöskirjassa selvitettiin niska-, hartia-, alaselkä- ja laaja-alaisten tuki- ja liikuntaelinkipujen esiintyvyyttä nuorilla. Päätavoite oli kuitenkin tutkia liikunnan, eri urheilulajien, liikkumattomuuden, istumisen ja unen laadun ja määrän yhteyttä niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Tutkimusaineisto muodostui Pohjois-Suomen syntymäkohortin 1986 nuorista, joiden laskettu syntymäaika oli 1.7.1985–30.6.1986. Nuorille lähetettiin 16-vuotiaana postikysely, joka sisälsi tuki- ja liikuntaelinoirekyselyn, kysymyksiä liikunnan, istumisen ja unen määrästä ja laadusta, sekä muista elämäntavoista. Kahden vuoden kuluttua, 18-vuotiaana lähetettiin toinen kysely joka sisälsi mm. tuki- ja liikuntaelinoirekyselyn. Tulokset osoittavat että niska-, hartia- ja alaselkäkivut olivat yleisiä nuoruudessa, joskin hoitoa vaativat kivut ja raajojen kipuoireilu olivat harvinaisia. Laaja-alaiset tuki- ja liikuntaelinkivut olivat odotettua yleisempiä. Tytöt oireilivat enemmän kuin pojat ja oireilu lisääntyi iän myötä. Hyvin aktiivinen liikunnan harrastaminen (6h/vko tai enemmän ripeää liikuntaa) ja erityisesti tietyt riskilajit olivat yhteydessä suurempaan niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Samoin suuri istumisen määrä, riittämätön uni ja huono unen laatu lisäsivät kipujen todennäköisyyttä. Nuorten tuki- ja liikuntaelinkipuja voitaisiin mahdollisesti vähentää vaikuttamalla muunneltavissa oleviin riskitekijöihin, kuten vähentämällä istumista, lisäämällä terveysliikuntaa, sekä parantamalla unitottumuksia. Tämän takia jatkossa tarvitaan näihin riskitekijöihin kohdistuvia interventiotutkimuksia
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Ford, Brendon Christopher. "Determining A Valid Model of Experimental Shoulder Pain." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20087.
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This thesis investigated whether experimental pain, with a particular focus on experimental shoulder pain, validly replicated the clinical experience of pain. One systematic review and one experimental study were conducted as part of the research program. The introduction chapter summarised the literature regarding prognosis and management of shoulder pain. A lack of reliable information regarding the muscle response to shoulder pain was identified as a potential cause of suboptimal management. Experimental pain was identified as the best option for determining the muscle response to pain due to the short-comings of other options, however, research has not been conducted to validate current models of experimental pain as a viable model for clinical shoulder pain. A systematic review of appendicular experimental pain models identified that investigated models of experimental pain reproduced pain in a similar distribution to clinical pain but largely did not reproduce the same emotional response. A low number of studies had comprehensively investigated experimental pain response to provocation. The experimental study established that experimental shoulder pain induced by hypertonic saline injection reproduced a similar distribution of pain but did not reproduce the emotional distress seen in clinical populations. Most subjects had a decrease or no change in pain in response to provocation. A valid model of experimental model of shoulder pain has not been established. The discussion chapter outlined to implications of the previous two chapters on previously conducted research involving motor response to experimental pain and the direction of future research.
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Grooten, Wim. "Work and neck/shoulder pain : risk and prognostic factors /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-848-7/.
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Lumpkins, Logan, and Craig Wassinger. "Effects of Lower Extremity Aerobic Exercise and Conditioned Pain Modulation on Evoked Shoulder Pain." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/434.
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Background: Emerging evidence suggests that aerobic exercise and conditioned pain modulation may be advocated in treating patients with musculoskeletal pain. The effects of lower extremity aerobic exercise and conditioned pain modulation on evoked shoulder pain are not known.
Purpose: To determine the acute effects of lower extremity aerobic exercise and conditioned pain modulation on outcomes of evoked shoulder pain from pain pressure threshold measurements.
Study Design: Repeated measures.
Methods: Thirty (30) healthy volunteers were tested over the course of two sessions. Session 1 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a conditioned pain modulation with cool water. Session 2 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a bout of lower extremity aerobic exercise on a recumbent stepper apparatus.
Results: Pain pressure threshold was not significantly influenced by the conditioned pain modulation using cool water (p=0.725). Pain pressure threshold was significantly increased immediately following the lower extremity exercise session (P<0.001).
Conclusion: Conditioned pain modulation with cool water did not produce any significant changes in pain pressure threshold. Lower extremity aerobic exercise acutely increased pain pressure threshold in participants with experimentally induced shoulder pain. Physical therapists may consider lower extremity aerobic exercise to produce short-term hypoalgesic effects and facilitate the application of more active interventions.
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Johansson, Kajsa. "Patients with subacromial pain : Diagnosis, treatment and outcome in primary care." Doctoral thesis, Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med834s.pdf.
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Hyvönen, P. (Pekka). "On the pathogenesis of shoulder impingement syndrome." Doctoral thesis, University of Oulu, 2003. http://urn.fi/urn:isbn:9514270258.
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Abstract
The pathomechanism of the shoulder impingement syndrome has been under debat. Two main theories of the pathogenesis of the disease exists; mechanical (extrinsic) and degenerative (intrinsic) theory.
The purpose of this work was to evaluate the pathogenesis of impingement syndrome with five studies that consentrate to aspects related to ethiopathology as outcome and recovery after surgery, radiological diagnosis, immunohisto- and histopathology of subacromial bursa, and subacromial mechanical pressures.
The good results of 14 shoulders of 96 operated with an open acromioplasty turned painful after an average of 5 (2 - 10) years postoperatively and had developed 6 full-thickness and 4 partial rotator cuff tears. Initially good result is not permanent in all cases, suggesting that a degenerative process is involved in the pathogenesis of impingement syndrome.
Shoulder muscle strengths of 48 patients, who had undergone an open acromioplasty, restored to near normal within one year after open acromioplasty, suggesting that mechanical compression plays a role in the pathogenesis of impingement syndrome.
Variation in the shape of the acromion, evaluated in 111 patients and their matched controls by a routine supraspinatus outlet view, is associated with impingement syndrome, but this association is weak. Validity of this radiograph in the diagnosis of impingement syndrome is therefore a minor adjunct to the other diagnostic methods.
The role of subacromial bursa in impingement syndrome was studied in 62 patients (33 tendinitis, 11 partial and 18 full-thickness RC tear) suffering from a unilateral impingement syndrome and 24 controls. Tenascin-C proved to be a more general indicator of bursal reaction compared to the conventional histological markers, being especially pronounced at the more advanced stages of impingement.
The local subacromial contact pressures measured in 14 patients and 8 controls with a piezoelectric probe were elevated in the impingement syndrome, supporting the mechanical theory.
On the basis of this study, both mechanical and degenerative factors are involved in the pathogenesis of impingement syndrome.
11
Voerman, Gerritje Evelien. "Musculoskeletal neck-shoulder pain a new ambulant myofeedback intervention approach /." Enschede : University of Twente [Host], 2007. http://doc.utwente.nl/57841.
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Ryans, Robert Ian. "The management and assessment of shoulder pain in primary care." Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288905.
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Burgel, Barbara J. "Psychosocial work factors and shoulder pain in hotel room cleaners." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3339180.
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Gustafsson, Louise. "The effectiveness of an in-patient management program for hemiplegic shoulder pain during rehabilitation and at six-month follow-up /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19292.pdf.
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Marks, Darryn M. "Substitution of an orthopaedic surgeon with a physiotherapist in the management of shoulder pain." Thesis, Griffith University, 2019. http://hdl.handle.net/10072/386539.
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Background:
Shoulder pain is a common problem and a challenge for public healthcare service providers.
Those suffering from it are often referred to an orthopaedic specialist in pursuit of a surgical
solution, only to be confronted with long waiting lists and in many instances, the news that
surgery is not recommended. As the population ages and demand for health services
increases, the need for more efficient service provision will intensify.
To address this challenge, traditional orthopaedic pathways are evolving. Today many
orthopaedic patients are seen by physiotherapists instead of doctors. This form of
professional substitution aims to reduce waiting periods and improve access to the most
appropriate care. Yet the health economic impact of expanding physiotherapist duties is not
well understood as research in this field has lacked scope and rigour, particularly in relation
to prescribing and injecting. Consequently, the optimal contribution of physiotherapists to
the delivery of efficient shoulder care is unclear.
Shoulder pain provides a clinical platform to explore the efficacy and efficiency of expanding
the role of physiotherapists in orthopaedic services. Orthopaedic shoulder care involves
assessment, diagnosis and management; selection of individuals for and provision of
corticosteroid injection, referral for physiotherapy, identification of individuals requiring
surgery and surgical care. Evaluation of the impact of professional substitution with a
physiotherapist should consider the safety, efficacy, efficiency and patient-acceptability of a
physiotherapist compared with an orthopaedic doctor.
Objective:
To investigate the health economic impact of substituting an orthopaedic surgeon with a
physiotherapist in the management of shoulder pain and determine the optimal role of
physiotherapists in the efficient care of patients referred to orthopaedics for shoulder pain.
Methods:
A number of studies were undertaken to meet the objective:
A systematic review was undertaken to clarify the safety, efficacy, cost effectiveness and
patient-acceptability of physiotherapists acting as a professional substitute for doctors, in the
management of musculoskeletal disorders. Unlike previous reviews (which predominantly
comprised of single-group observational case series), the only studies included were those
that directly compared management by a physiotherapist with management by a doctor. To
address methodological deficiencies identified in the systematic review and related evidence
gaps, a series of studies (linked to an overarching randomised controlled trial protocol) were
designed.
New and unfiltered general practitioner-referred adults with shoulder pain from the
orthopaedic waiting list were recruited to attend orthopaedic outpatients at a large public
hospital in Australia. Baseline data were collected from 277 participants, of which 274 were
assessed by both a physiotherapist and an orthopaedic surgeon and 64 entered an RCT before
receiving pragmatic usual care. This permitted three separate investigations:
• The economic burden of shoulder pain was estimated with a two-part cost-of-illness
analysis. Retrospective cost and impact data, together with work absenteeism and
presenteeism information provided by the 277 participants was used to estimate the
economic burden of patients on the orthopaedic waiting list. In addition, the cost of
hospital care provided to those 277 participants was calculated over a two-year period.
• The efficacy and efficiency of physiotherapist decision making was investigated with an
agreement study which compared a physiotherapist and orthopaedic surgeon’s care
decisions in 274 participants who were independently assessed by the physiotherapist
and the orthopaedic surgeon. Shoulder pain diagnosis and management, including
decisions regarding investigations and selection for subacromial corticosteroid injection,
were compared using inter-rater reliability statistics.
• A double blinded non-inferiority randomised controlled trial investigated the efficacy and
efficiency of the physiotherapist delivering subacromial corticosteroid and local
anaesthetic injection compared with the surgeon. Participants deemed appropriate for
injection in their assessment with both the physiotherapist and the orthopaedic surgeon
(N=64), were randomized to receive the injection from either one of these professionals.
All subjects received routine post-injection physiotherapy (not delivered by the injecting
physiotherapist). The primary outcome was the shoulder pain and disability index (SPADI)
administered at baseline, six and 12-weeks. The EuroQoL (EQ-5D-5L) supported a within
trial cost utility analysis undertaken from the perspective of the health funder.
Results:
Fourteen studies of moderate to low quality met the inclusion criteria for the systematic
review. While substitution of the doctor with a physiotherapist in the management of
musculoskeletal disorders did not change health outcomes and produced inconsistent
variation in resource use, there were major methodological shortcomings: in all but two
studies, selective inclusion criteria removed more complex cases rendering the study cohort
different to usual orthopaedic populations, there was insufficient health economic data to
judge efficiency and there was no information about prescribing or injecting by
physiotherapists in comparison to doctors. Consequently, the efficacy and efficiency of
physiotherapist roles in shoulder care was unclear.
The cost-of-illness study revealed that public orthopaedic waiting lists create a large cost
burden for society. The mean societal cost of healthcare and domestic support was
AU$20.72 per day (AU$7563 annually) per patient on the orthopaedic waiting list. When
absenteeism and presenteeism are included, the cost per patient who was employed was
AU$61.31 per day (AU$22,378 annually) calculated with the Work Productivity and Activity
Impairment Questionnaire (WPAI). The mean per patient cost to government of public
hospital care was AU$2622 in year one and AU$3836 (SD 4961) over two years. Care
delivery lacks efficiency with a surgical conversion rate of only 22% and with 51% of hospital
care cost attributable to outpatient services.
The agreement study revealed that the physiotherapist made safe and very similar shoulder
management decisions to the orthopaedic surgeon, with no apparent impact upon the
utilization of healthcare resources. There was near perfect agreement between the
physiotherapist and consultant orthopaedic surgeon regarding diagnosis, investigation,
surgical versus non-surgical care, referral for physiotherapy treatment and judgement of the
safety of subacromial injection of corticosteroid and local anaesthetic. The physiotherapist
was moderately less inclined to use subacromial injection as an immediate treatment.
The non-inferiority RCT and health economic analysis supported the hypothesis that a
physiotherapist can prescribe and deliver subacromial corticosteroid and local anaesthetic
injection at least as effectively and at less expense than a consultant orthopaedic surgeon.
Conclusion:
A physiotherapist trained in prescribing and injection of corticosteroids and local anaesthetic,
can safely, efficaciously, less expensively and with high patient satisfaction, be a professional
substitute for the orthopaedic surgeon with respect to the non-surgical components of
shoulder care including patient assessment, management, and delivery of subacromial
injection.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medicine
Griffith Health
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Breckenridge, John David. "Perceptual Changes in People with Shoulder Pain: Motor Imagery, Left/Right Judgement and Sensory Tactile Thresholds." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20192.
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Shoulder pain is one of the most common musculoskeletal problems for which people seek health care advice and management, and according to the World Health Organisation, musculoskeletal problems disorders are the second largest cause of disability worldwide. Shoulder pain can become persistent and one example of this is frozen shoulder (adhesive capsulitis), a chronic and disabling shoulder problem. The diagnosis of shoulder complaints including frozen shoulder is difficult, and not without controversy, as there are currently no gold standard diagnostic tests. The treatment of shoulder complaints including frozen shoulder is similarly debated in the literature. This lack of consensus in diagnoses and treatment of shoulder complaints implies that new methods of assessment and treatment are required. A large body of work has implicated the role of the brain in chronic pain conditions. Neuroplastic changes associated with chronic pain can be assessed directly, for example, by the neuroimaging of sensory or motor cortex changes. Neuroplastic changes associated with chronic pain can also be inferred indirectly by behavioural experiments. These include motor imagery tasks such as the left/right judgement task, and tactile acuity tasks like the two-point discrimination threshold test. The first part of thesis systematically reviews the literature surrounding the left/right judgement task in chronic pain conditions to determine if motor imagery is affected in people with chronic pain. This revealed a notable gap in the left/right judgement task literature, as no study had yet assessed motor imagery in people with shoulder pain. The second part of this thesis describes the development of a shoulder specific left/right judgement task, its validity and reliability, which was the first step to address this gap in the literature. In the third part of this thesis this new shoulder specific motor imagery test was then applied to a self-selected sample of people with shoulder pain, and then to a clinician confirmed cohort of people with frozen shoulder. Motor imagery was found to be affected in the frozen shoulder group, and one possible explanation for this is that central processes and cortical proprioceptive representations were altered in this group. In a second behavioural experiment, a tactile acuity task – the two point discrimination test – was employed in the frozen shoulder cohort, and the results demonstrated side to side differences in two point discrimination. Again, this could be interpreted as further implication of somatosensory cortical changes in this group. Taken together, these findings of motor imagery impairment and tactile acuity deficits in people with persistent shoulder pain (frozen shoulder) imply sensorimotor cortical alterations in this group. Moreover, these findings raise the possibility that cortically targeted treatments – that have proven successful in other conditions such as complex regional pain syndrome, and shown promise in chronic low back pain – may be beneficial in the management of frozen shoulder.
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Moore, Stephanie D. "Predictors of Outcome Following Standardized Rehabilitation for Patients with Shoulder Pain." UKnowledge, 2013. http://uknowledge.uky.edu/rehabsci_etds/15.
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Shoulder dysfunction is frequently treated and persistent symptoms are common. Differential diagnosis of shoulder injuries can be challenging and knowledge of a diagnosis alone does not appear to be enough information to predict outcomes. Determination of a set of factors that predict outcome would assist clinicians in making the most effective treatment decision for patients with shoulder pain. The purposes of this dissertation were to investigate patient-clinician agreement in an orthopedic population of patients with shoulder pain and to determine what combination of factors best predicts positive patient-reported outcome following standardized rehabilitation in patients with shoulder pain.
In the first study, it was determined that patient-clinician agreement was moderate to good. This further supports the use of patient reported outcomes as an appropriate approximation of “true” outcome. In the second study, patient-nominated functional limitations were reduced to 14 categories for inclusion as candidate predictors in the prediction model. In the third study, we observed that the combination of absence of neck pain, shorter duration of symptoms and report of exercise as a functional limitation were associated with greater odds of positive clinical outcome following 6 weeks of standardized rehabilitation. Due to limited sample size, generalizations cannot yet be made to other samples. Future investigation of this model in a larger sample and subsequent external validation in a separate sample are necessary to further develop the model for clinical use.
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Busse, Linda. "Prevalence of shoulder pain among young Swedish swimmers : A retrospective study." Thesis, Linnéuniversitetet, Institutionen för idrottsvetenskap (ID), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-73957.
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Kelson, Denean M. "Muscle Activation Patterns and Chronic Neck-Shoulder Pain in Computer Work." Thesis, Virginia Tech, 2018. http://hdl.handle.net/10919/83759.
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Prolonged computer work is associated with high rates of neck and shoulder pain symptoms, and as computers have become increasingly more common, it is becoming critical that we develop sustainable interventions targeting this issue. Static muscle contractions for prolonged periods often occur in the neck/shoulder during computer work and may underlie muscle pain development in spite of rather low relative muscle load levels. Causal mechanisms may include a stereotypical recruitment of low threshold motor units (activating type I muscle fibers), characterized by a lack of temporal as well as spatial variation in motor unit recruitment. Based on this theory, although studies have postulated that individuals with chronic neck-shoulder pain will show less variation in muscle activity compared to healthy individuals when engaged in repetitive/monotonous work, this has seldom been verified in empirical studies of actual computer work.
Studies have rarely addressed temporal patterns in muscle activation, even though there is a consensus that temporal activation patterns are important for understanding fatigue and maybe even risks of subsequent musculoskeletal disorders. This study applied exposure variation analysis (EVA) to study differences in temporal patterns of trapezius muscle activity as individuals with and without pain performed computer work. The aims of this study were to: Assess the reliability of EVA to measure variation in trapezius muscle activity in healthy individuals during the performance of computer work; Determine the extent to which healthy subjects differ from those with chronic pain in trapezius muscle activity patterns during computer work, measured using EVA.
Thirteen touch-typing, right-handed participants were recruited in this study (8 healthy; 5 chronic pain). The participants were asked to complete three 10-minute computer tasks (TYPE, CLICK and FORM) in two pacing conditions (self-paced, control-paced), with the healthy group completing two sessions and the pain group completing one. Activation of the upper trapezius muscle was measured using surface electromyography (EMG). EMG data were organized into 5x5 EVA matrices with five amplitude classes (0-6.67, 6.67-20, 20-46.67, 46.67-100, >100% Reference Voluntary Exertion) and five duration classes (0-
1, 1-3, 3-7, 7-15, >15 seconds). EVA marginal distributions (along both amplitude and duration classes) for each EVA class, as well as summary measures (mean and SD) of the marginal sums along each axis were computed. Finally, “resultant” mean and SD across all EVA cells were computed. The reliability in
EVA indices was estimated using intra-class correlation coefficients (ICC), coefficient of variation (CV) and standard error of measurement (SEM), computed from repeated measurements of healthy individuals (aim 1), and EVA indices were compared between groups (aim 2).
Reliability of EVA amplitude marginal sums ranged from moderate to high in the self-paced condition and low to moderate in the control-paced condition. The duration marginal sums were moderate in the self-paced condition and moderate to high in the control-paced condition. The summary measures (means and
SDs) were moderate to high in both the self-paced and control-paced condition. Group comparisons revealed that individuals with chronic pain spent longer durations of work time in higher EVA duration categories, exhibited larger means along the amplitude, duration and in the resultant, and higher EVA SD
in the amplitude and duration axes as compared to the healthy group.
To our knowledge, this is the first study to report on the reliability of EVA applied specifically to computer work. Furthermore, EVA was used to assess differences in muscle activation patterns as individuals with and without chronic pain engaged in computer work. Individuals in the pain group seemed to exhibit prolonged sustained activation of the trapezius muscle to a significantly greater extent than controls, even though they did not experience pain during the performance of the computer tasks (as obtained through self-reports). Thus, these altered muscle recruitment patterns observed in the pain subjects, even in the absence of task-based pain/discomfort, are suggestive of chronic motor control changes occurring in adaptation to pain, and may have implications for the etiology of neck and upper-limb musculoskeletal disorders.Master of Science
This study aims to assess the reliability of exposure variation analysis (EVA) to measure variation in trapezius muscle activity in healthy individuals during the performance of computer work, and to determine the extent to which healthy subjects differ from those with chronic pain in trapezius muscle activity patterns during computer work, measured using EVA. Muscle activation was recorded for eight healthy individual and five suffering from chronic neck-shoulder pain. The data were then categorized into amplitude and continuous time categories, and summary measures of resulting distributions were calculated. These measures were used to assess the reliability of participant responses to computer work of healthy individuals, as well as quantify differences between those with and without chronic pain. We found that individuals with pain activated their neck-shoulder muscles for longer continuous durations than healthy individuals, thus showing an inability to relax their muscles when performing work.
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Björnsson, Hallgren Hanna Cecilia. "Treatment of subacromial pain and rotator cuff tears." Doctoral thesis, Linköpings universitet, Ortopedi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-82094.
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Shoulder pain is very common, affecting 14-21 % of the population at some time during their lifetime. The aims of this thesis were to improve the understanding of various aspects concerning the pathogenesis and treatment of subacromial pain and rotator cuff tears. Patients and healthy individuals were examined and compared in five studies: Study I) Seventy patients were retrospectively examined, clinically and with ultrasound, 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at surgery. Ultrasound showed significantly fewer rotator cuff tears compared to the prevalence of asymptomatic tears reported in the literature for the same age group. This indicates that arthroscopic subacromial decompression might protect the rotator cuff. Study II) Forty-two patients were retrospectively examined, clinically and with ultrasound, 39 months (mean) after an acute rotator cuff repair. All patients had pseudoparalysis after trauma, a full thickness tear and no previous history of shoulder symptoms. A delay in surgical treatment of three months and the number of tendons injured did not affect the outcome. Age affected outcome negatively. Study III) Plasma samples from 17 patients with cuff tears and 16 plasma samples from healthy age- and gender-matched controls were collected and analysed regarding the levels of matrix metalloproteinases and their inhibitors, TIMP1-4. Elevated levels of TIMP-1 were found in the patients with cuff tears compared to controls. Higher levels of TIMP-1, TIMP-3 and MMP-9 were found in patients with full-thickness tears compared to patients with partial-thickness tears. Study IV) Ninety-seven patients with longstanding subacromial pain, on the waiting-list for arthroscopic subacromial decompression, were prospectively randomised to specific shoulder exercises or control exercises for three months. Thereafter they were clinically examined and asked if they still wanted surgery. The specific shoulder exercises focusing on eccentric exercise for the rotator cuff and scapula stabilisers were found to be effective in reducing subacromial pain and improving shoulder function, thereby reducing the need for surgery. Study V) All patients including those operated, in Study IV were re-examined after one year using clinical assessment scores. The option of surgery was continuously available up to the one-year follow-up. Ultrasound and radiological examinations performed at inclusion were analysed in relation to the choice of surgery. The positive effects of the specific exercise programme were maintained after one year and significantly fewer patients in this group chose surgery. Surgery was significantly more often chosen by patients who had a low baseline shoulder score, and/or a full thickness rotator cuff tear. All patients showed significant improvement in the clinical scores one year after inclusion or one year after surgery. These results support the concept that subacromial pain has a multifactorial aetiology and that the first line of treatment should be specific shoulder exercises. When conservative treatment fails, an acceptable result can be achieved with arthroscopic subacromial decompression. The rotator cuff status is important to consider when treating and studying these patients.
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Fredriksson, Kerstin. "On causes of neck and shoulder pain in the general population : epidemiological studies on associations between workload and leisure-time activities, and disorders in the neck/shoulder region /." Stockholm : National Institute for Working Life (Arbetslivsinstitutet), 2000. http://diss.kib.ki.se/2000/91-7045-570-8/.
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McLarty, Callum. "A pilot study to identify links between genetic variation and shoulder pain and dysfunction after breast cancer radiotherapy." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33800.
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Introduction – Treatment for breast cancer is associated with a risk of chronic shoulder and upper limb morbidity in up to 30% of patients. There is currently no consensus for the possible reason for this often repeated finding in the literature. Previous research has suggested that development of fibrotic tissue in response to cancer treatments such as surgery and radiotherapy could be an underlying cause of musculoskeletal dysfunction and pain. This study investigated if any genetic variants in several key fibrosis-modulating genes could be shown to be associated with risk of upper limb musculoskeletal dysfunction and pain in breast cancer survivors. Participants and Methods – A cross sectional study design was employed, using a candidate gene approach. A total of 326 South African breast cancer survivors were recruited from a tertiary hospital in the Western Cape (343 total, minus 17 samples with insufficient data collected). Each participant was scored for symptom severity using the shoulder pain and disability index (SPADI) questionnaire. Participants were then grouped for symptom severity using low, med or high SPADI scores. The low SPADI group served as controls (controls n=273, cases n=70). Participants were invited to donate a blood sample from which DNA was extracted. Each DNA sample was genotyped at seven polymorphic sites; three in TGF-ß, two in ATM, one in SOD2 and one in XRCC1, using PCR technologies and TaqMan allelic-discrimination probes. The resultant genotypes were analysed using multivariate analysis, including inferred haplotype analysis to search for association to shoulder pain and morbidity after treatment. A logistic regression analysis was also performed to investigate the association between SPADI score and age of participant. Results – When participant age was compared with symptom severity, it was found that younger participants were more likely to have moderate-to-severe symptoms than older participants. There was a significant difference in the minor allele frequencies between case and control groups for the rs4880 (C>T, SOD2) polymorphism. The T allele was present more in the case group than in controls, with minor allele frequencies of 0.67 vs 0.55 respectively. No other independent associations were noted for any of the remainder variants tested. When haplotypes were inferred for genes SOD2 and ATM, combinations between the rare alleles at rs4880 and rs1800058 (C>T, ATM) were associated (F=4.35, pT and ATM rs1800058 is recommended for further study, in addition to the rs4880 polymorphism in SOD2. These novel results are suggesting that there may be an association between fibrotic genes and the development of upper limb sequelae after treatment for breast cancer. A larger case-control study would be required to validate and explore these findings.
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Yeung, Wai-chow David, and 楊煒秋. "A pilot study of holistic energy healing for frozen shoulder." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45169548.
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Siivola, S. (Sari). "Neck and shoulder pain in a young population: prevalence and etiological factors." Doctoral thesis, University of Oulu, 2003. http://urn.fi/urn:isbn:9514271009.
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Abstract
This study comprised three parts: a cross-sectional survey of 826 high school students, a 7-year follow-up survey of the same sample, and a MRI study of a subgroup (n=31) of the follow-up study population. Firstly, the aims of the study were to determine the prevalence and incidence of neck and shoulder pain (NSP) in populations 15-18 and 22-25 years old, and to evaluate sociodemographic factors, body size measurements, psychological factors and leisure time activities as possible associated and predictive factors of NSP. Secondly, the aim was to find out whether structural changes of the cervical spine detected by magnetic resonance imaging (MRI) were associated with NSP in young adults.
The results showed the prevalence of self-reported weekly NSP in 15- to 18-year-old adolescents to be 17%, and in seven years, the prevalence of weekly NSP had increased to 28%. After seven years, the six-month incidence of occasional or weekly NSP was 59% among those asymptomatic at baseline. In the cross-sectional study, female gender, low physical activity, hobbies which statically load the upper extremities, low intensity of physical exercise, self-assessed moderate physical condition and psychosomatic symptoms and depressive mood were associated with a high prevalence of NSP, and sports which dynamically load the upper extremities were associated to a low prevalence of NSP.
Symptoms in adolescence were associated with a high prevalence of NSP seven years later. Activity in sports, which dynamically load the upper extremities in adolescence, was associated with a low prevalence of NSP in adulthood. Of all variables in the study, psychosomatic symptoms were most congruently associated with a high prevalence of NSP, and psychosomatic symptoms in adolescence also predicted NSP in adulthood. In the MRI study, disc degeneration and anular tears of the cervical spine were common in asymptomatic and symptomatic subjects. Disc herniations were the only abnormal finding that was significantly more common in symptomatic subjects.
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Jabornik, Kirsten. "The effect of swimming training load on supraspinatus tendon thickness and shoulder pain in elite swimmers." Thesis, Federation University Australia, 2021. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/183615.
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Swimming is one of the top three participant sports in Australia and enjoys a high public profile. Shoulder injuries are commonly sustained by swimmers and are associated with significant morbidity as well as impaired swimming performance. Supraspinatus tendinopathy has been found to be present in a large proportion of competitive swimmers. The use of ultrasound has been found to be a reliable and valid tool in assessing supraspinatus tendon thickness changes. Primarily this thesis investigated the relationship between changes in supraspinatus tendon thickness and shoulder pain among elite Australian swimmers. The thesis investigated how swimming practice load and intensity resulted in supraspinatus tendon thickness changes. Furthermore, retrospective data investigates the link between training related supraspinatus tendon thickness changes and future incidence of shoulder pain. The research ascertained that swimming practice results in significantly greater increases in supraspinatus tendon thickness in swimmer’s shoulders with a history of shoulder pain. The evaluation of volume and intensity demonstrated a greater increase in thickness as a result of high intensity low volume practice compared with that of high volume low intensity practice in swimmer’s shoulders without a history of pain. While retrospective data identified a significant association between the increase in tendon thickness immediately post a swimming practice and the tendon thickness at six hours post practice and the incidence of significant interfering shoulder pain at both three and six months post testing. These findings provide an evidence base for the use of supraspinatus tendon thickness measures to assess a swimmer’s readiness to train when returning from an episode of shoulder pain. Additionally, the shoulder tendon response to varying training loads, including different intensity and volume and how this may be associated with future incidence of pain may guide coaches and clinical staff in the planning of training programs and training periodisation to manage shoulder pain incidenceDoctor of Philosophy
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King, Jacqlyn. "Sensorimotor Abnormalities in Chronic Subacromial Pain: The Influence of Sex, Contribution of Pain, and Utility of Using the Contralateral Limb as a Control." Thesis, University of Oregon, 2018. http://hdl.handle.net/1794/23190.
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Patients with subacromial pain syndrome (SPS) display a number of sensorimotor deficits including alterations in pain processing, poor proprioception, and weakness at the symptomatic limb. The primary purpose of this dissertation was to explore whether the aforementioned deficits: (1) can be quantified by using the non-involved limb as a measure of control, (2) are purely localized to the symptomatic limb or represent a more generalized deficit, (3) are influenced by the presence of subacromial pain, and (4) present similarly in male and female patients. Here, we utilized modern clinical techniques in both a patient cohort with SPS and uninjured control cohort to address these aims. The results of this dissertation are applicable towards treatment of SPS as well as scientific understanding of sex on sensorimotor behavior.
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Davidsen, Roar Oskar. "Daytime stress, shoulder/neck-pain, and the relation to nocturnal heart rate variability." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for bevegelsesvitenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-13155.
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Stress and musculoskeletal pain (MSP) may affect the regulation of the autonomic nervous system. Earlier studies have revealed that subjects with MSP show reduced heart rate variability (HRV) during sleep indicating an increased sympathetic drive at rest. However, it is unclear whether daytime exposures, such as work stress, stress in leisure, and daytime MSP, affect nocturnal HRV. The aim of this study was therefore to investigate the possible association between daytime stress, shoulder/neck pain (SNP), and nocturnal HRV. Twenty-five female subjects working in health care service participated in the study. Subjective scores of stress and pain were obtained on an hourly basis throughout the workday and subsequent evening. An index for long-term pain was also calculated. Electrocardiography (ECG) was monitored at the end of the workday and until 1 hour after awakening the morning after. Both time and frequency HRV parameters were extracted for further analyses. High stress in leisure time was associated with higher nocturnal HRV (p< .05). In contrast, long-term pain tended to be associated with reduced HRV. Pain or stress during the workday had no effect on nocturnal HRV. The differences between groups were all found for the time domain variable pNN50. No difference was present for the frequency domain parameter. The results of this study both agree with, and are in contrast to earlier studies of MSP and the association with nocturnal HRV. The contrasting results make it difficult to draw a conclusive remark and further studies are needed to elucidate the association between stress, shoulder/neck pain, and nocturnal HRV.
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Lomond, Karen. "Shoulder function and movement adaptations to repetitive reaching: effects of fatigue and pain." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=95027.
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Studies suggest that repetitive arm movements are risk factors for the development of fatigue and pain; yet the interaction between movement repetition and pain is poorly understood. The objective of this thesis was to quantify the pain- and time-related characteristics associated with chronic neck/shoulder pain during several movement tasks. Shoulder function was assessed in subjects with chronic neck/shoulder pain (intensity ≥ 3/10 for > 3 months, n = 16) (PAIN) and an age- and sex-matched control group (n = 16) (CTRL) on two visits and immediately before and after they performed a repetitive reaching task (RRT) to voluntary termination. During the RRT, we recorded whole-body three-dimensional kinematics, forces underneath both feet and electromyography from five neck and/or shoulder muscles; heart rate, and ratings of pain and perceived exertion were recorded periodically throughout the RRT. The PAIN group showed substantial inter-session variability in some but not all shoulder functional measures. Also, group differences in shoulder Range of Motion (RoM) were observed, such that our protocol may be useful in effectively assessing functional impairment in people with chronic neck/shoulder pain. Both groups demonstrated similar decreases in power output, suggesting that this parameter may be a fatigue-, rather than pain-sensitive outcome. Posture and movement adaptations to the RRT were unique to each group. The CTRL group increased their arm joint RoM, bringing the arm closer to the targets, while PAIN used a more fixed, en block arm pattern, and increased Center of Mass (CoM) motions, likely to reduce the load on the injured structures. During the RRT, CTRL decreased their arm's reach-to-reach relative variability, while PAIN increased arm and decreased CoM relative variability. Analyses of time to peak velocity indicated increased within-reach inter-joint coupling in the CTRL group only. Despite initial differences in movement strategies, both groups mLe mouvement répétitif représente un facteur de risque de fatigue et de douleur; cependant, l'interaction entre la répétition et la douleur est mal comprise. Notre objectif était de quantifier les caractéristiques de douleur et de temps associées à la douleur chronique cou-épaule durant plusieurs tâches. La fonction a été mesurée chez des participants avec douleur cou-épaule chronique (intensité ≥ 3/10 durant > 3 mois, n = 16) (DLR) et chez un groupe contrôle apparié selon le sexe et l'âge (n = 16) (CTRL) à deux visites et avant et après une tâche d'atteinte répétitive (TAR) jusqu'à terminaison volontaire. Durant la TAR, nous avons enregistré la cinématique tridimensionnelle, les forces sous les pieds et l'électromyographie de cinq muscles de la région cou-épaule; la fréquence cardiaque, et les scores de douleur et d'effort perçu ont été enregistrés périodiquement durant la TAR. Le groupe DLR a démontré de la variabilité inter-session considérable dans certaines, mais pas chaque, mesures fonctionnelles. Des différences de groupe d'Amplitude de mouvement (AdeM) d'épaule ont été observées, suggérant que notre protocole peut servir à évaluer efficacement les déficits fonctionnels chez les gens avec douleur cou-épaule. Les groupes ont démontré des diminutions semblables de puissance, suggérant que celle-ci peut être une mesure de résultat de fatigue, plutôt que de douleur. Les adaptations posture-mouvement à la TAR étaient uniques à chaque groupe. Le groupe CTRL a augmenté les AdeM du bras, l'amenant plus près des cibles, et le groupe DLR utilisait un patron plus fixe, en bloc, et augmentait l'AdeM du Centre de masse (CdeM), réduisant la charge des structures blessées. Durant la TAR, le groupe CTRL diminuait la variabilité relative inter-mouvement du bras, et le groupe DLR augmentait celle du bras et diminuait celle du CdeM. L'analyse des délais d'atteinte de vitesses maximales a indiqué une augmenta
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Dutton, Megan. "The effects of scapulothoracic rehabilitation on shoulder pain in competitive swimmers Megan Dutton." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/3012.
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Includes abstract.Includes bibliographical references.
Competitive swimmers have a high incidence of shoulder pain. Secondary shoulder impingement is thought to be primarily responsible for shoulder pain in competitive swimmers. The effective management of shoulder impingement has been widely investigated; however there is minimal consensus on the optimal method of treatment and rehabilitation of shoulder impingement. In addition, current research does not adequately consider the role of scapulothoracic rehabilitation in the management of shoulder impingement. Aim: To determine the effects of a scapulothoracic rehabilitation programme on shoulder pain in competitive swimmers.
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Bargon, Gabriella Maria. "The association of body representation and nociceptive sensitivity measures with shoulder pain and disability prior to and twelve months after shoulder surgery." Thesis, Curtin University, 2019. http://hdl.handle.net/20.500.11937/77265.
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Multidimensional factors have been identified for the development and persistence of shoulder pain. More recently alterations in the Central Nervous System (CNS) have been identified in musculoskeletal pain. This study aimed to determine the association between measures of body representation and nociceptive sensitivity, and shoulder pain and disability prior to and 12 months following rotator cuff surgery. Measures indicative of altered CNS processing were related to pain and disability prior to but not following surgery.
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李思聞. "肩痛的激痛點針刺取穴方案初探." HKBU Institutional Repository, 2017. https://repository.hkbu.edu.hk/etd_oa/449.
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研究背景：肩痛是临床的常见症状，常因不正确姿势、受凉、外伤、运动劳损等引发，多被诊断为局关节周围炎、属部的肌臆炎等’带来的疼痛和肢体活动障碍都严重影响正常生活。针灸治疗盾痛效果显著’传统中医在眉痛的诊疗中已有详尽论边，而近年西方医学提出的激痛点疗法，在治疗痛症上也有明确的疗效。总结局痛的激痛点针刺取穴方案，探讨其与传统针灸的失系’对发展当代针灸有十分重要的理论意义和临床价值。研究目的：初步总结盾痛的激痛点针刺取穴方案，探讨激痛点和传统针灸的相关性, 为临床提供新思路。研究方法：文献研究。结论：眉痛的激痛点针刺取穴方案为：盾前痛取胸大肌锁骨部、胸小肌、肱二头肌、喙肱肌、背阔肌、冈下肌、前三角肌、前斜角肌、中斜角肌激痛点；属后痛取大圆肌、小圆肌、肩胛下肌、肱三头肌长头第一、下斜方肌第三、后三角肌激痛点；肩外侧疼痛取中三角肌、冈上肌激痛点。此法优势在于理论系统与诊疗过程明确、操作规范、疗效显著，是属痛的治疗的新思路。对比发现，激痛点理论与经筋理论相似。激痛点针刺取穴与中医整体辨证论治的结合, 势必有助提高临床疗效，值得深入探索。關键字：肩痛激痛点针刺取穴文献研究
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Ettinger, Lucas. "The Influence of Subacromial Pain on Scapular Kinematics, Muscle Recruitment and Joint Proprioception." Thesis, University of Oregon, 2013. http://hdl.handle.net/1794/13417.
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Subacromial impingement accounts for significant burdens on the economy and individual quality of life. The development and progression of this disorder is thought to be related to overuse; however, little is known regarding biomechanical factors such as scapular kinematics, shoulder muscle recruitment and joint proprioception with respect to this disorder. The high degree of variability between individuals on these biomechanical measures limits our ability to make inferences behind the development of shoulder impingement. Here, biomechanical factors associated with impingement are investigated using within-subjects designs in order to reduce this inherent variability. Using modern clinical techniques, this dissertation is applicable towards treatment of shoulder impingement as well as scientific understanding of motor control and function in the presence of pain.
This dissertation includes previously published and un-published co-authored material.
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Leijon, Ola. "Exposure assessment : gender and context, and target groups for prevention of neck/shoulder and low back pain /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-616-6/.
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Fanavoll, Rannveig. "Association between work stress, physical exercise, and chronic shoulder/neck pain: the HUNT Study." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for bevegelsesvitenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-17483.
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Background: It is well documented that high work stress and low job control is associated with increased risk of shoulder/neck pain while regular physical exercise reduces this risk. However, there is limited knowledge about the combined effect of work stress and physical exercise on risk of chronic pain in shoulders/neck. The first objective of this study was to investigate the role of work stress and physical exercise as individual risk factors for chronic shoulder/neck pain in a large unselected population of women and men. A second objective was to investigate the combined effect of work stress and physical exercise on risk of chronic shoulder/neck pain. Methods: The Nord-Trøndelag health study (the HUNT Study) was conducted in 1984-1986 (HUNT 1), with follow-up in 1995-1997 (HUNT 2). All women and men who participated in both surveys were included in the present study. After exclusions, the study population consisted of 12,530 women and 16,896 men for the analysis of work stress and job control on risk of chronic shoulder/neck pain, and 8,057 women and 11,028 men for the analysis including physical exercise. Relative risk (RR) of chronic shoulder/neck pain in HUNT 2 associated with work stress, job control, and physical exercise at baseline (HUNT 1) was estimated by a general lineal model. Results: At follow-up, 4,357 (34,7%) women and 4,470 (26.5%) men reported chronic shoulder/neck pain. Work stress showed a strong dose-response association with risk of chronic shoulder/neck pain (P-trend <.001) for both women and men. Women and men who reported to be exposed to work stress almost all the time had RRs of 1.32 (95% confidence interval [95% CI] 1.11-1.58) and 1.68 (95% CI 1.41-2.00), respectively. The effect of job control on chronic shoulder/neck pain was weak, both among women and men. The different measures of physical exercise (i.e., frequency, duration, and intensity) all showed a moderate inverse dose-response effect on risk of chronic shoulder/neck pain in both women and men (10-20% reduced risk among the most active). The combined analysis showed that individuals who reported high stress levels and who exercised ≥2 sessions per week had a RR of 1.35 (95% CI 1.06-1.72) compared to a RR of 1.64 (95% CI 1.26-2.12) among inactive individuals with similar stress level. Conclusion: This prospective study indicates that women and men who perceive their work situation as stressful have an increased risk of chronic shoulder/neck pain. There was a moderate inverse relation between physical exercise and risk of chronic shoulder/neck pain for both women and men. Regular physical exercise can, to some extent, compensate for the adverse effect of work stress on risk of chronic shoulder/neck pain.
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Tran, Gui Tong. "The role of ultrasound and the patient acceptable symptom state in shoulder pain management." Thesis, University of Leeds, 2019. http://etheses.whiterose.ac.uk/22763/.
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Shoulder pain is a common musculoskeletal condition and affects a large proportion of the UK population. Over half of those affected continue to have pain eighteen months from onset. In order to help with the diagnosis and management of shoulder pain, the use of ultrasound scans has been increasing. Despite this rise in ultrasound scans, the predictive value of ultrasound-based pathology findings with outcomes remains unclear. Not all patients in pain necessarily require investigations or treatment. Evaluating the relationship between pain and an acceptable symptom state is also important to understand which patients require interventions. The over-arching hypothesis underlying this thesis was that aspects of the shoulder pain pathway can be improved through better utilisation of ultrasound and applying the concept of a patient acceptable symptom state. A systematic literature review on the role of imaging and shoulder symptoms identified a paucity of studies evaluating multiple concurrent imaging pathologies with shoulder symptoms. A retrospective study using latent class analysis demonstrated that groups of ultrasound-detected pathologies existed. A prospective study confirmed the existence of these groups. However, there was no difference in 6 months outcome or response to treatments between these groups or individual pathologies. Patients with worse symptoms at baseline were more likely to find worse symptoms acceptable at 6 months. Patients who reported acceptable symptoms at baseline also received fewer treatments. In summary, the current use of ultrasound scans in managing patients with shoulder pain needs re-evaluation, and understanding clinical criteria such as the patient acceptable symptom state will help improve shoulder pathways. These findings should inform future trial designs and shoulder care pathways.
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McRobert, Cliona. "Primary care decision-making for shoulder pain : identifying treatment effect moderators using clinical expertise." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5162/.
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Background: Shoulder pain is a common, costly condition with variable prognosis. Commonly used treatments for shoulder pain in primary care include: (i) advice & analgesia, (ii) exercise and/or manual therapy, and (iii) corticosteroid injection. Current guidelines do not assist clinicians in optimal treatment selection for this condition. Prognostic factors help identify subgroups likely to have poor prognosis, however their potential to help clinicians decide between different treatments is unclear. Methods: A systematic review identified which patient attributes modify effects of these three treatments. Clinical consensus workshops were conducted with 21 UK-based clinicians who manage shoulder pain to identify patient attributes relevant to treatment decision making. The impact of these attributes on treatment choice was studied in a conjoint analysis study of decision-making for shoulder pain. Results: The review identified 20 potential treatment effect moderators, with low quality evidence. Clinical consensus workshops identified 12 salient patient attributes. The conjoint study received responses from 387 clinicians (31 countries, 64% UK). Results showed that 11 of the 12 attributes discriminated between treatment choices, following adjustment for responders’ country, profession, and experience. Recommending injection was most strongly associated with lack of improvement (OR 2.81, 95%CI 2.16; 3.65), previous positive response to injection (2.79, 2.07; 3.76), and patient preference (2.41, 1.82; 3.19). Recommending physiotherapy was most strongly influenced by patient preference (2.77,2.16; 3.55), presence of weakness/instability (2.05, 0.79; 1.23) and previous positive response to physiotherapy (2.22, 1.76; 2.80). Not recommending corticosteroid injection was associated with traumatic onset and unstable diabetes or cardiac issues, whereas not recommending physiotherapy was associated with sleep disturbance and high pain. Discussion: The relative importance of patient attributes that influence shoulder treatment selection was quantified. Logical clinical patterns emerged suggesting that specific patient attributes guide clinicians treatment selection. Future research is indicated to assess if identified attributes indeed modify treatment effects.
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Oliver, Delphine. "The effect of shoulder pain on the neuromuscular activity of the scapular stabilizing muscles." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/2991.
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Includes bibliographical references (leaves 71-79).Neuromuscular activity of the scapular stabilizing muscles in subjects with and and without chronic shoulder impingement syndrome. To examine differences in neuromuscular activity of the scapular stabilizing muscles in subjects with and without chronic shoulder impingement syndrome during an abduction movement of the shoulder.
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Kalezic, Nebojsa. "Autonomic reactivity in muscle pain : clinical and experimental assessment." Doctoral thesis, Umeå universitet, Kirurgisk och perioperativ vetenskap, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-919.
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There are numerous indications of possible involvement of the autonomic nervous system in the genesis of chronic pain. The possibility exists that sympathetic activation is related to motor dysfunction and changes in sensory processing, which have otherwise been implicated in musculoskeletal disorders. The primary aim of the thesis has been to investigate autonomic regulation at rest and in response to laboratory tests of autonomic function in subjects suffering from chronic pain in different localisations (lower back, neck-shoulder and neck-jaw), as well as to study the relations between autonomic regulation, proprioceptive acuity and clinical data. Secondary aim has been to assess autonomic regulation in fit, pain-free subjects in response to experimentally induced pain and in occupationally relevant settings. A total of 194 subjects suffering from chronic pain participated [low back pain (LBP) n=93; non-traumatic neck pain (NT) n=40, Whiplash associated disorder (WAD) n=40, Whiplash with temporomandibular dysfunction (WADj) n=21]. Each chronic pain group was subjected to a battery of autonomic function tests combining cognitive (Stroop Colour-Word conflict tests), physical (handgrip), sensory (unpleasant sound) and motor tasks (chewing tests) as well as the activation of reflex pathways (paced breathing and the orthostatic test) and compared to an age- and gender balanced control group. Autonomic regulation was also assessed in exposure to experimentally induced muscle pain in healthy subjects (n=24) in order to describe acute pain reaction. Further assessment was carried out during monotonous repetitive work and dynamic work in healthy subjects (n=10) and in a three-day monitoring of ambulance personnel (n=26) in occupational settings. Autonomic regulation was evaluated using cardiovascular (heart rate and heart rate variability, local blood flow and blood pressure), respiratory (breathing rate) electrodermal (skin conductance), muscular (trapezius and masseter EMG) and biochemical (insulin, cortisol, catecholamines) variables. Proprioceptive acuity was assessed using active-active repositioning tests. Pain levels were assessed using Visual-analogue or Numerical Rating scales. General health was evaluated through the Short-Form SF-36 Health Related Quality of Life questionnaire and Self-Efficacy Score questionnaires, whereas dysfunction was evaluated using the Oswestry Low Back Pain questionnaire, Pain Disability and Neck Disability Index questionnaires, the McKenzie evaluation and primary healthcare diagnoses. Self-reports of pain, stress and exertion were acquired prior to, during and post-testing. Chronic pain subjects were characterised by increased sympathetic and decreased parasympathetic activity as reflected in heart rate (LBP, WAD, WADj), heart rate variability (LBP, WAD, WADj), blood pressure (WADj) and electrodermal activity (LBP). In general, WAD showed more pain and dysfunction than NT, with lower self-efficacy and health-related quality of life. Differential reactivity was observed only in WAD, with increased responsiveness to sensory stimuli (heart rate variability, electrodermal activity), and motor tasks (heart rate) and a decreased response to cognitive challenge (heart rate variability, electrodermal activity). A significant part of WADj subjects showed sensorimotor impairment and low endurance in chewing tests, concomitant with a cardiovascular response that correlated with pain levels. Proprioceptive acuity was not found to be impaired among subjects suffering from chronic pain, and there were no indications of significant individual response specificity. Response to experimentally induced muscle pain in healthy subjects was also characterised by a prominent cardiovascular component. In simulated occupational settings autonomic activation and transient insulin resistance were detected in healthy subjects following monotonous repetitive work, with no similar effects following dynamic exercise. Modest deviations in circadian heart rate variability patterns during workdays were detected in ambulance personnel reporting more pronounced musculoskeletal symptoms, with no such effects on work-free days. Autonomic balance observed in chronic pain subjects was characterised by a trend towards increased sympathetic activity in comparison with pain-free controls. Moderate signs of affected reactivity to autonomic function tests were observed in patients with WAD, however no specific reaction patterns have been observed in any chronic pain group. Correspondence between the intensity of pain and autonomic activity was observed in acute pain and in chronic pain groups characterised by higher pain levels. As indicated by autonomic and neurohormonal changes in the recovery from real and simulated work, further studies with physiological monitoring of the effects of work-related stress are warranted for better understanding of the mechanism of musculoskeletal disorders.
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NIGITO, CRISTINA. "New tools in rehabilitation medicine for the treatment of impingement shoulder pain and for the treatment of cervicobrachialgia and low back pain." Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2009. http://hdl.handle.net/2108/208594.
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Obiettivo degli studi: valutare l‟efficacia del trattamento con diatermia da contatto in pazienti affetti da sindrome da conflitto di spalla e avviare una valutazione di due diverse patologie a carico della colonna, come la lombosciatalgia e la cervicobrachialgia, relativa all'applicazione di una tecnologia di recente generazione che consiste in una neuro stimolazione basata sulla somministrazione di sequenze programmate di impulsi elettrici bifasici ad alto voltaggio, di ridotta durata e bassa frequenza,caratterizzata dalla presenza di un segnale asimmetrico, a valore medio nullo, con una componente fortemente negativa.Per il primo studio sono stati trattati 11 soggetti.I pazienti esaminati, dei quali, il 45% maschi e l‟55% femmine, sono ricompresi in un ampio range di età e risultano distribuiti, essenzialmente, nelle fasce di età fra i 40 ed i 67 anni. Gli outcome utilizzati per valutare l‟efficacia del trattamento sono stati la VAS e la valutazione della funzionalità della spalla tramite somministrazione della scala di Constant Murley. Il protocollo di trattamento prevede tre sedute settimanali di diatermia per due settimane per un totale di sei sedute. Il test “t di Student” conferma che i risultati conseguiti in termini di incremento del punteggio complessivo della “Scala di Constant Murley” sono attribuibili alla terapia praticata. Quindi possiamo, con buona confidenza, dire che l'utilizzo di un sistema a trasferimento energetico capacitivo e resistivo nella sindrome da conflitto di spalla produce un effetto positivo. Ad analoga conclusione si giunge attraverso il test “chi quadrato”. Al fine di rendere più robusto il giudizio qui formulato sulla base dei casi trattati, occorrerebbe proseguire nella sperimentazione anche attraverso un incremento della numerosità del campione.
Nel secondo studio l'obiettivo si è basato sulla ricerca di un programma terapeutico capace di risolvere in modo significativo la sintomatologia dolorosa nei pazienti con lombosciatalgia e cervicobrachialgia .Sono state confrontate le variabili quali dolore ed articolarità a T0 e a T1 L‟ipotesi è che i risultati ottenuti siano statisticamente significativi. Il primo gruppo di trenta soggetti ha seguito un percorso terapeutico di dieci giorni che comprendeva neurostimolazione con programma predefinito per il trattamento di "lombosciatalgia" con durata di 33 minuti circa. Il secondo gruppo di trenta soggetti ha seguito lo stesso protocollo utilizzando la neurostimolazione con il programma "Cervicobrachialgia"con durata di 21 minuti circa. I gruppi trattati con neurostimolazione presentano una rapida e significativa riduzione del sintomo doloroso (t-test lombo sciatalgia p
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Braun, Cordula. "Predicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tears." Thesis, Teesside University, 2016. http://hdl.handle.net/10149/621790.
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Rotator cuff disorders encompass a range of impairments from tendinopathy to partialor full-thickness rotator cuff tears, and represent the largest subgroup of shoulder pain. Rotator cuff tears, most of which are atraumatic, are common in adults with shoulder pain and are strongly associated with increasing age. Conservative treatment including physiotherapy is the first-line treatment, but some patients do not respond, and ultimately require surgery. Early predictions of response could allow individuals’ care pathways to be optimised, preventing unnecessary delays and suffering and benefiting patients and healthcare providers alike. My primary aim was to develop a prognostic model for the outcome of physiotherapy in adults with painful atraumatic partial-thickness tears (PTTs) of the rotator cuff. This was addressed by a prospective prognostic model study. The study was underpinned by a systematic review of prognostic models in adults undergoing physiotherapy for painful rotator cuff disorders and was further informed and complemented by the following work: the development and validation of the physiotherapy protocol for the prognostic study; the identification, selection and definition of the candidate prognostic factors for the prognostic study; the estimation of the Minimal Important Difference (MID) of the study’s primary outcome measure (the Western Ontario Rotator Cuff Index, WORC); and an exploratory responder analysis of the WORC outcome scores. The prognostic systematic review, prognostic study, MID analysis and responder analysis are original contributions to knowledge. The prognostic systematic review revealed important methodological deficiencies in the five included studies, and no clinically usable model. No study addressed a distinct PTT population. The process of identifying factors for my own prognostic model study revealed a lack of knowledge about the prognostic relevance of factors. All of the candidate models I explored in my prognostic study (n sample = 65, n analysed = 61) had low performance and precision. The estimated MID of the WORC was -300. The responder analysis resulted in different proportions of responders to treatment depending on the responder definition. My results highlight the difficulties involved in predicting outcomes in the field of shoulder pain and rotator cuff disorders, and the need for methodologically sound prognosis research.
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Silva, Marcos Gomes da. "A ultra-sonografia na avaliação da síndrome do ombro doloroso - Análise de urna série de casos." reponame:Repositório Institucional da FIOCRUZ, 2005. https://www.arca.fiocruz.br/handle/icict/5925.
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Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-12-05T18:23:14Z
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Marcos Gomes da Silva A ultra sonografia... 2005.pdf: 32482863 bytes, checksum: 577d11de768274646dcc96446a704746 (MD5)Made available in DSpace on 2012-12-05T18:23:14Z (GMT). No. of bitstreams: 1 Marcos Gomes da Silva A ultra sonografia... 2005.pdf: 32482863 bytes, checksum: 577d11de768274646dcc96446a704746 (MD5) Previous issue date: 2005
Escola Bahiana de Medicina e Saúde Pública / Centro de Pesquisas Gonçalo Moniz
Com objetivo de estudar os possíveis achados uitra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avallados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluidos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipo de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador.
Seventy-seven patients with clinical diagnostic of painful shoulder sent to ultrasonographic investigation were assessed in order to study the possible ultrasonographic findings of the painful shoulder syndrome (PSS). Besides the image findings, we tried to identify clinical and epidemiological variables which could be associated to the presence of pathological disorders. Among the 77 patients included in the study, we found ultrasonographic abnormalities in 47 patients (61%). The most common finding among the abnormal exams was the lesion of the rotator cuff in 38 patients (80%), classified as tendinopathy, partial rupture or complete rupture. Nine patients (20%) with abnormal exams presented other lesions, such as bursitis (5 cases) and joint effusion (4 cases), without other associated alterations. Among the clinical and epidemiologic variables assessed, age over 51 years and the presence of joint disability were associated to abnormal ultrasound results for these patients. The rotator cuff lesion was associated to the presence of joint effusion and the need of the use of anti-infiammatory drugs. We have reached the conclusion that sonography is an important method of assessing patients with PSS. In this study, factors such as age and joint disability were associated with the presence of the rotator cuff lesion
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Huis, in 't Veld Maria Hendrika Aleida. "Work-related neck-shoulder pain the role of cognitive-behavioural factors and remotely supervised treatment /." Enschede : University of Twente [Host], 2007. http://doc.utwente.nl/58101.
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Kitkowski, Taylor Morgan, and Taylor Morgan Kitkowski. "Physical Therapy Modalities: How they Work and their Effectiveness in the Treatment of Shoulder Pain." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/625021.
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The purpose of this paper is to explain the parts, administration, mechanism of action,
and beneficial effects of four different physical therapy modalities: Ultrasound, Transcutaneous
Electric Nerve Stimulation, Dry Needling, and Cupping. Ultrasound, and Transcutaneous Nerve
Stimulation have been used in physical therapy clinics for many years, whereas dry needling and
cupping are newer to the physical therapy practice. All four of these modalities are commonly
used in treatment, which begs the question of whether they are effective. This paper presents the
research and findings from multiple sources on the effectiveness of these different modalities in
regards to shoulder pain.
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Hinsley, Hannah. "Age related tendon degeneration : the relationship between rotator cuff tears, shoulder pain and functional loss." Thesis, University of Oxford, 2018. http://ora.ox.ac.uk/objects/uuid:f7e98030-62c8-4b44-b059-b8b874f83127.
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Background The shoulder is the third most common site of musculoskeletal symptoms with an estimated 20% of the population reporting symptoms at any given time. Rotator cuff tears are the most common shoulder disorder, and the major debilitation patients seek help for is pain. Full thickness rotator cuff tears have an estimated prevalence of between 7 and 27%, but studies have shown that not all of these are symptomatic. Many case series have been set in shoulder clinics and may have drawn false causality between rotator cuff tears and pain. This study uses a community population-based cohort to determine the epidemiology of rotator cuff tears and test the association between rotator cuff tears, pain, and functional losses. Methods 463 consecutive subjects (926 shoulders) have undergone a multidisciplinary assessment of their shoulders including high-definition ultrasound, the Oxford shoulder score and myometric strength testing. Individuals were part of the Chingford 1000 women cohort, which is a 20-year-old longitudinal population study comprising 1003 women aged between 64 and 87, and is representative of the population of the UK. Results The population prevalence of full-thickness tears was 22.2%, of which 4.6% were bilateral which increased significantly with age. The prevalence was greater in the dominant arm with a 1.64 increase in relative risk. The population prevalence of all tendon abnormalities was 59.3%, of which 30.2% were bilateral, increasing with age. Although 48.4% of full-thickness tears were asymptomatic there was an association between rotator cuff tears and patient reported symptoms. The relative risk of symptoms compared to normal tendons was 1.97 for abnormal tendons, 2.20 for full-thickness tears<2.5cm, and 4.74 for full-thickness tears >2.5cm (p<0.001). Individuals with at least one full-thickness tear had a relative risk of symptoms 1.97 that of those with bilateral normal tendons (p<0.001). Quantitative shoulder strength reduced with age, (10.2-16.2%, p<0.001), the non-dominant arm (4.9%, p<0.001), and the presence of pain (10.8%, p<0.001). Rotator cuff tears had no independent effect, but a significant interaction with age. Strength was preserved in the under 70's irrespective of rotator cuff tear, but in the over 70's there was decrease in strength of between 33% and 39% irrespective of pain (p=0.004). Conclusions This study provides an epidemiological basis to the understanding of rotator cuff tears. The prevalence of full-thickness tears in a female population aged 64-87 was 22.2%. Although only half of all full-thickness tears are symptomatic there is a statistically significant increase in the likelihood of symptoms with increasing tear pathology. There is also an association with loss of strength but only in the over 70's.
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Looft, Patrik. "The effects of preventive training programs on shoulder injury, pain, and strength in overhead athletes – a review." Thesis, Linnéuniversitetet, Institutionen för idrottsvetenskap (ID), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-103780.
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Background Shoulder pain and injury is common in both the general population and among athletes. Overhead athletes, such as handball players, are at an even higher risk of shoulder injury. There is currently no consensus regarding how or if these injuries can be prevented. Purpose The aim of this review was to examine whether preventive training programs reduce acute and/or overuse injuries in overhead athletes. Another aim was to examine if training programs increase the strength of the rotator cuff in overhead athletes. Method Searches were made in PubMed, Cinahl, and Sport Discus in March and April 2021. Ten studies were included in the study. The PEDro-scale was used to assess methodological quality and GRADE was used to determine level of evidence. Results The methodological quality was “moderate to high” for five of the studies. The remaining five studies were of lower quality. The level of evidence was “limited” for prevention and “inadequate” for rotator cuff strength. Conclusion The evidence for prevention of shoulder injuries was “limited” and the evidence for rotator cuff strength was “inadequate”. A narrower focus on one sport might result in more robust evidence. Keywords overhead athlete, prevention, shoulder, strength
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Skillgate, Eva. "Back and neck pain : epidemiological studies on some risk factors and treatments, including naprapathic manual therapy /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-405-1/.
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Hallman, David. "Autonomic nervous system regulation in chronic neck-shoulder pain : Relations to physical activity and perceived stress." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-187613.
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Neck-shoulder pain (NSP) is a highly prevalent musculoskeletal disorder with unclear causes, and effective prevention and treatment require a further understanding of the underlying mechanisms. Aberrant autonomic nervous system (ANS) regulation is a hypothesized causal element in the development and maintenance of chronic muscle pain. The overall aim of this thesis was to investigate possible differences in ANS regulation between chronic NSP and healthy control (CON) groups using both laboratory assessment and ambulatory monitoring in daily life. Four papers are included in this thesis, based on data from three groups with chronic NSP. Autonomic responses to laboratory stressors were assessed using heart rate variability (HRV), blood pressure, trapezius muscle activity and blood flow measurements (Study І) in NSP and CON. Long-term ambulatory monitoring of HRV, physical activity and perceived symptoms were assessed in Studies ІІ and IV to investigate group differences in real-life conditions. Finally, the effects of a ten-week intervention (using individually adjusted HRV biofeedback) to reinstating ANS balance in subjects with chronic NSP were evaluated using self-reported symptoms and health ratings, as well as autonomic regulation testing (i.e., evaluating HRV at rest and in response to stress) (Study ІІІ). The main findings from the four studies demonstrated aberrant ANS regulation in the NSP group compared to CON, which was predominantly characterized by diminished parasympathetic cardiac activity during rest and sleep, and altered sympathetic reactivity to laboratory stressors (Studies І, ІІ and IV). Different patterns in physical activity were observed between the NSP and CON groups, with reduced physical activity during leisure time in the NSP group (Studies ІІ and IV). Physical activity was found to be positively associated with HRV. Positive effects of HRV-biofeedback were found on perceived health, including social function, vitality and bodily pain, and improved HRV (Study ІІІ). In conclusion, imbalanced ANS regulation was demonstrated among persons with chronic NSP at both the systemic and local levels. Diminished parasympathetic activity in NSP was modulated by lower levels of physical activity in leisure time. Interventions targeting ANS functions might benefit persons with chronic NSP.
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Altmann, Janet Rosemary. "Neck and shoulder pain in nurses working in seven wards of Tygerberg hospital : quantifying the problem and exploring the risks." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6893.
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Thesis (MSc)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: Background: There is a high prevalence of musculoskeletal problems, including neck and shoulder pain (NSP) among nurses worldwide. Tygerberg hospital (TBH) is the second largest hospital in South Africa with a large complement of nurses. The prevalence of NSP and risks associated therewith have not previously been determined at TBH. It is unknown how the nurses at TBH experience NSP in their workplace. Objective: This study questioned whether the 12 month prevalence of neck pain, shoulder pain and combined NSP is similar to worldwide reports, and questioned the degree of association of NSP with lower back pain and demographic risk factors in the nursing population at TBH. Thereafter the qualitative experiences of nurses with NSP at TBH were elucidated. Methodology: A self-designed Neck and Shoulder Pain Questionnaire for nurses (NSPn) was distributed among seven wards of TBH from March to May 2009. The NSPn was compiled using the pain definition from the Nordic Musculoskeletal Questionnaire and elements of the Dutch Musculoskeletal Questionnaire. The NSPn gathered information regarding the presence of neck and shoulder pain as well as demographic and workplace risk factors. Thereafter semi-structured interviews were conducted with eight nurses working at TBH. Results: The 12 month prevalence of neck pain, shoulder pain and combined NSP was 29%, 34% and 43% respectively among a sample of 143 nurses. A high correlation of neck pain with lower back pain and of neck pain with shoulder pain was observed. No significant associations were found between age, ward module, tenure of work, and the nurses' perception of their general health and fitness with the presence of NSP. The qualitative results describe the conflict between the nurses' beliefs and their symptoms. The nurses named work-related stress as the most prevalent cause or aggravator of NSP. The main underlying cause of their stress was a shortage of nursing staff. Discussion and Conclusions: The prevalence of neck pain (29%) and shoulder pain (34%) among the surveyed TBH nurses was lower than the worldwide prevalence summary statistic of 50% and 52% respectively. However, the NSP prevalence (43%) was within the range of three international studies, suggesting that NSP is a significant concern for TBH nurses. The nurses' desire to hide pain and continue working perpetuates the problem of NSP. The underlying causes of NSP are multifactorial, with physical factors interacting with psychosocial factors. Preventative drives need to consider staffing levels and nurses' methods of coping with stress along with improvements in manual handling practices.
AFRIKAANSE OPSOMMING: Agtergrond: Daar is 'n hoё voorkoms van muskulosketale probleme, insluitend nek en skouer pyn (NSP), by verpleegkundiges wêreldwyd. Tygerberg Hospitaal (TBH) is die tweede grootste hospitaal in Suid-Afrika met 'n groot aantal verpleegkundiges. Die voorkoms van NSP en risiko's verbonde daaraan, is nog nie voorheen by TBH vasgestel nie. Dit is nie bekend hoe die verpleegkundiges by TBH NSP in hulle werksomgewing ervaar nie. Objektief: Hierdie studie ondersoek of die 12 maand teenwoordigheid van nekpyn, skouerpyn en gekombineerde NSP ooreenstem met wêreldwye aanmelding, en ondersoek die assosiasie van NSP met lae rugpyn en demografiese risiko faktore in die verpleegkunde populasie by TBH. Daarna is die kwalitatiewe ondervindings van die verpleegkundiges met NSP by TBH toegelig. Metodologie: Die self-ontwerpde "Nek en Skouer pyn in verpleegsters‟(NSPn) vraelys, is onder sewe sale vanaf Maart tot Mei 2009 versprei. Die NSPn het die die Nordiese muskuloskeletale pyn definisie en elemente vanaf die "Hollandse Bewegingsapparaat Vraelys‟ ingesluit. The NSPn het inligting oor die voorkoms van nek en skouer pyn, sowel as demografiese en werkplek faktore ingesamel. Daarna is semi-gestruktureerde onderhoude gevoer met agt verpleegkundiges wat by TBH werksaam is. Resultate: Die 12 maand voorkoms van nekpyn, skouerpyn en gekombineerde NSP was 29%, 34% en 43% onderskeidelik in die steekproef van 143 verpleegkundiges. 'n Beduidende korrelasie van nekpyn met lae rugpyn en nekpyn met skouerpyn is waargeneem. Geen betekenisvolle ooreenkomste is gevind tussen ouderdom, saal module, termyn van werk en die verpleegkundiges se persepsie van hulle algemene gesondheid en fiksheid, met die teenwoordigheid van NSP nie. Die kwalitatiewe resultate beskryf die konflik tussen die verpleegkundiges se oortuigings en hulle simptome. Die verpleegkundiges noem stres as die mees algemene oorsaak of verergeraar van NSP. Die grootste onderliggende oorsaak van stres was die tekort aan verpleegpersoneel by TBH. Bespreking en Gevolgtrekkings: Die voorkoms van nekpyn (29%) en skouerpyn (34%) was laer as die wereldwye voorkoms opsommings statistiek van 50% en 52% onderskeidelik. Maar die voorkoms van NSP(43%) was binne die grense van drie internasionale studies wat dui daarop dat NSP 'n merkbare kommer vir TBH verpleegkundiges is. Die verpleegkundiges se behoefte om die pyn weg te steek en aan te hou werk, vererger die problem van NSP. Die onderliggende oorsake van NSP is veelvoudig, met fisiese faktore en psigologiese faktore wisselwerkend op mekaar. Voorkomende veldtogte moet verpleegkundiges se stres en personeeltekorte saam met verbetering in manuele hanteringstegnieke in ag neem.
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Costa, Susana Valentim. "Prevalência lesiva em atletas de voleibol: efeitos da implementação do protocolo “FIFA 11+ S” na funcionalidade do complexo articular do ombro." Bachelor's thesis, [s.n.], 2017. http://hdl.handle.net/10284/6263.
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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em FisioterapiaIntrodução: O ombro dos atletas de voleibol é submetido a forças repetitivas que podem proporcionar alterações biomecânicas e originar uma alta incidência de lesões nesta articulação. Objetivo: Este estudo tem como propósito analisar a prevalência de lesões em voleibolistas, e demostrar se o protocolo do “FIFA 11+S” promove alterações funcionais no complexo articular do ombro. Metodologia: Quinze atletas da federação portuguesa de voleibol (FPV) do sexo masculino, do escalão júnior, divididos em dois grupos foram submetidos a uma avaliação da força muscular dos rotadores do ombro no isocinético, e da funcionalidade do complexo articular do ombro através do “shoulder mobility test”. Durante 3 semanas foi aplicado o protocolo “FIFA 11+S” ao grupo experimental (GE), com uma periocidade de quatro vezes por semana, e com a duração de 30 minutos. Resultados: Após aplicação do protocolo constatou-se que os atletas do GE não apresentaram alterações significativas no “mobility shoulder test”, no peak torque, défices, nem a nível de rácios dos músculos rotadores do ombro. Conclusão: O protocolo “FIFA 11+S” não alterou de um modo significativo a funcionalidade do complexo articular do ombro.
Introduction: The shoulder of volleyball athletes is subjected to repetitive forces that can provide biomechanical alterations and lead to a high incidence of lesions in this joint. Objective: This study aims to analyze the prevalence of lesions in volleyball players, and demonstrate whether the protocol of "FIFA 11 + S" promotes functional alterations in the joint shoulder complex. Methodology: Fifteen athletes from Portuguese volleyball Federation (FPV) male junior echelon divided in two groups, were subjected to an evaluation of the rotator of the shoulder muscle strength in isokinetic and mobility of the shoulder joint complex through the "shoulder mobility test". During 3 weeks the Protocol "FIFA 11 + S" has been applied to the experimental group (GE) with a periodicity of four times a week, and with the duration of 30 minutes. Results: After application of the Protocol was found that GE athletes did not show significant changes in the "mobility shoulder test", in peak torque, deficits, or the level of ratios of the rotator shoulder. Conclusion: The Protocol "FIFA 11 + S" did not alter significantly the functionality of shoulder joint complex.
N/A
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Rissén, Dag. "Repetitive and monotonous work among women : Psychophysiological and subjective stress reactions, muscle activity and neck and shoulder pain." Doctoral thesis, Stockholm University, Department of Psychology, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-1234.
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Repetitive and monotonous work is frequently associated with neck and shoulder pain and negative psychosocial factors inducing stress reactions. The present thesis concerns the relations between psychophysiological and subjective stress reactions, muscle activity measured by surface electromyography (SEMG) in the trapezius muscle, and neck and shoulder pain in women performing repetitive and monotonous work. In Study I cardiovascular and subjective stress reactions were investigated during computer work in a laboratory setting. The findings indicated that heart rate variability is a more sensitive and selective measure of mental stress compared with blood pressure recordings. Study II explored the relations between stress reactions and muscle activity during supermarket work. The results showed that perceived negative stress reactions may have a specific influence on muscle activity in the neck and shoulder region, which can be of importance for work-related musculoskeletal disorders in repetitive and monotonous work. In Study III the association between SEMG activity patterns and neck and shoulder pain was investigated during cash register work. It was found that pain-afflicted women had a different muscle activation pattern (more static, more co-contraction, less muscle rest) compared with pain-free women. Study IV was a follow-up study evaluating the introduction of job rotation among female cashiers. The results indicated positive effects on diastolic blood pressure, muscle activity, and partly on neck and shoulder pain, although perceived stress was unchanged. It was concluded that job rotation seems to have a limited effect on chronic neck and shoulder pain, but may be an effective preventive measure. The empirical findings are particularly relevant for women who, compared with men, more often perform repetitive and monotonous work and are also more often affected by neck and shoulder pain.