STUDY DESIGN: Single-blind randomized clinical trial, with a follow-up of 24 weeks.
OBJECTIVE: To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy.
BACKGROUND: Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established.
METHODS: Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment.
RESULTS: At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms.
CONCLUSION: In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.
The subacromial syndrome is the most common source of shoulder pain. The mainstays of conservative treatment are non-steroidal anti-inflammatory drugs and exercise therapy. Recently, low-level laser therapy (LLLT) has been popularized in the treatment of various musculoskeletal disorders. The aim of this study is to evaluate the additive effects of LLLT with exercise in comparison with exercise therapy alone in treatment of the subacromial syndrome. We conducted a randomised clinical study of 80 patients who presented to clinic with subacromial syndrome (rotator cuff and biceps tendinitis). Patients were randomly allocated into two groups. In group I (n = 40), patients were given laser treatment (pulsed infrared laser) and exercise therapy for ten sessions during a period of 2 weeks. In group II (n = 40), placebo laser and the same exercise therapy were given for the same period. Patients were evaluated for the pain with visual analogue scale (VAS) and shoulder range of motion (ROM) in an active and passive movement of flexion, abduction and external rotation before and after treatment. In both groups, significant post-treatment improvements were achieved in all parameters (P = 0.00). In comparison between the two groups, a significant improvement was noted in all movements in group I (P = 0.00). Also, there was a substantial difference between the groups in VAS scores (P = 0.00) which showed significant pain reduction in group I. This study indicates that LLLT combined exercise is more effective than exercise therapy alone in relieving pain and in improving the shoulder ROM in patients with subacromial syndrome.
Objective: To compare the effectiveness of radial extracorporeal shockwave treatment with that of supervised exercises in patients with shoulder pain. Design: Single blind randomised study. Setting: Outpatient clinic of physical medicine and rehabilitation department in Oslo, Norway. Participants: 104 patients with subacromial shoulder pain lasting at least three months. Interventions: Radial extracorporeal shockwave treatment: one session weekly for four to six weeks. Supervised exercises: two 45 minute sessions weekly for up to 12 weeks. Primary outcome measure: Shoulder pain and disability index. Results: A treatment effect in favour of supervised exercises at 6, 12, and 18 weeks was found. The adjusted treatment effect was -8.4 (95% confidence interval -16.5 to -0.6) points. A significantly higher proportion of patients in the group treated with supervised exercises improved - odds ratio 3.2 (1.3 to 7.8). More patients in the shockwave treatment group had additional treatment between 12 and 18 weeks - odds ratio 5.5 (1.3 to 26.4). Conclusion: Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain. Trial registration: Clinical trials NCT00653081.
OBJECTIVE: To compare the effectiveness of manual therapy and ultrasound (US) with manual therapy and placebo ultrasound (placebo US) in the treatment of new episodes of unilateral shoulder pain referred for physiotherapy.
METHODS: In a multicentre, double blind, placebo-controlled randomized trial, participants were recruited with a clinical diagnosis of unilateral shoulder pain from nine primary care physiotherapy departments in Birmingham, UK. Recruitment took place from January 1999 to September 2001. Participants were 18 yrs old and above. Participants all received advice and home exercises and were randomized to additionally receive manual therapy plus US or manual therapy plus placebo US. The primary outcome measure was the Shoulder Disability Questionnaire (SDQ-UK). Outcomes were assessed at baseline, 2 weeks, 6 weeks and 6 months. Analysis was by intention to treat.
RESULTS: A total of 221 participants (mean age 56 yrs) were recruited. 113 participants were randomized to US and 108 to placebo US. There was 76% follow up at 6 weeks and 71% at 6 months. The mean (95% CI) reduction in SDQ scores at 6 weeks was 17 points (13-26) for US and 13 points (9-17) for placebo US (P = 0.06). There were no statistically significant differences at the 5% level in mean changes between groups at any of the time points.
CONCLUSIONS: The addition of US was not superior to placebo US when used as part of a package of physiotherapy in the short-term management of shoulder pain. This has important implications for physiotherapy practice.
In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance. Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff, with calcification measuring 10 mm or more in maximum dimension. The primary outcome measure was the change in the Constant and Murley Score. A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean of 110 (41 to 255) days after treatment when the increase in Constant and Murley score was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the low-energy group. The improvement from the baseline level was significant in the high-energy group, with a mean gain of 12.5 (-20.7 to 47.5) points (p < 0.0001). The improvement was not significant in the low-energy group. Total or subtotal resorption of the calcification occurred in six patients (15%) in the high-energy group and in two patients (5%) in the low-energy group. High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up, but the calcific deposit remains unchanged in size in the majority of patients.
BACKGROUND AND PURPOSE: Radial shock-wave therapy (RSWT) is a pneumatically generated, low- to medium-energy type of shock-wave therapy. This single-blind, randomized, "less active similar therapy"-controlled study was performed to evaluate the effectiveness of RSWT for the management of calcific tendinitis of the shoulder.
SUBJECTS: Ninety patients with radiographically verified calcific tendinitis of the shoulder were tested.
METHODS: Subjects were randomly assigned to either a treatment group (n=45) or a control group (n=45). Pain and functional level were evaluated before and after treatment and at a 6-month follow-up. Radiographic modifications in calcifications were evaluated before and after treatment.
RESULTS: The treatment group displayed improvement in all of the parameters analyzed after treatment and at the 6-month follow-up. Calcifications disappeared completely in 86.6% of the subjects in the treatment group and partially in 13.4% of subjects; only 8.8% of the subjects in the control group displayed partially reduced calcifications, and none displayed a total disappearance.
DISCUSSION AND CONCLUSION: The results suggest that the use of RSWT for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain and improvement of shoulder function after 4 weeks, without adverse effects.
STUDY DESIGN: Random allocation of subjects into a placebo-controlled, crossover study.
OBJECTIVES: To investigate the effect of changing thoracic and scapular posture on shoulder flexion and scapular plane abduction range of motion in asymptomatic subjects, and in subjects with subacromial impingement syndrome.
BACKGROUND: Changes in upper body posture and concomitant imbalance of the muscle system have been proposed as one of the etiological mechanisms leading to subacromial impingement syndrome. Although clinicians commonly assess posture and devise rehabilitation programs to correct posture, there is little evidence to support this practice.
METHODS AND MATERIALS: Selected postural, range of movement, and pain measurements were investigated in 60 asymptomatic subjects and 60 subjects with subacromial impingement syndrome, prior to and following thoracic and scapular taping intended to change their posture.
RESULTS: Changing posture had an effect on all components of posture measured (P<.001) and these changes were associated with a significant increase (P<.001) in the range of motion in shoulder flexion and abduction in the plane of the scapula. Changing posture was not found to have a significant effect on the intensity of pain experienced by the symptomatic subjects, although the point in the range of shoulder elevation at which they experienced their pain was significantly higher (P<.001).
CONCLUSIONS: The findings of this investigation suggest that changing 1 or more of the components of posture may have a positive effect on shoulder range of movement and the point at which pain is experienced.
<b>CONTEXT: </b>Extracorporeal shock wave therapy (ESWT) has been used to treat calcific tendonitis of the shoulder, but trials of ESWT for this purpose have had methodological deficiencies and thus there is limited evidence for its effectiveness.<b>OBJECTIVE: </b>To determine whether fluoroscopy-guided ESWT improves function, reduces pain, and diminishes the size of calcific deposits in patients with chronic calcific tendonitis of the shoulder.<b>Design, Setting, and Participants: </b>Double-blind, randomized, placebo-controlled trial conducted between February 1997 and March 2001 among 144 patients (of 164 screened) recruited from referring primary care physicians, orthopedic surgeons, and sports physicians in 7 orthopedic departments in Germany and Austria.<b>INTERVENTIONS: </b>Either high-energy ESWT, low-energy ESWT, or placebo (sham treatment). The 2 ESWT groups received the same cumulative energy dose. Patients in all 3 groups received 2 treatment sessions approximately 2 weeks apart, followed by physical therapy.<b>MAIN OUTCOME MEASURES: </b>The primary end point was the change in the mean Constant and Murley Scale (CMS) score from baseline to 6 months after the intervention. Secondary end points were changes in the mean CMS scores at 3 and 12 months, as well as changes in self-rated pain and radiographic change in size of calcific deposits at 3, 6, and 12 months.<b>RESULTS: </b>Of 144 patients enrolled, all completed treatment as randomized and 134 completed the 6-month follow-up. Both high-energy and low-energy ESWT resulted in significant improvement in the 6-month mean (95% confidence interval [CI]) CMS score compared with sham treatment (high-energy ESWT: 31.0 [26.7-35.3] points; low-energy ESWT: 15.0 [10.2-19.8] points; sham treatment: 6.6 [1.4-11.8] points; P<.001 for both comparisons). Patients who received high-energy ESWT also had significant 6-month CMS improvements compared with those who received low-energy ESWT (P<.001). We found similar results for both the 3-month and 12-month CMS comparisons, as well as for self-rated pain and radiographic changes at 3, 6, and 12 months.<b>CONCLUSIONS: </b>Both high-energy and low-energy ESWT appeared to provide a beneficial effect on shoulder function, as well as on self-rated pain and diminished size of calcifications, compared with placebo. Furthermore, high-energy ESWT appeared to be superior to low-energy ESWT.
Single-blind randomized clinical trial, with a follow-up of 24 weeks.
OBJECTIVE:
To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy.
BACKGROUND:
Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established.
METHODS:
Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment.
RESULTS:
At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms.
CONCLUSION:
In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.
