Short stem total hip arthroplasty: Potential explanations for persistent post-surgical thigh pain.
Abstract: Short stem uncemented femoral implants were developed with the aim of preserving proximal bone stock for future revisions, improving biomechanical reconstruction, aiding insertion through smaller incisions and potentially decreasing or limiting the incidence of thigh pain. Despite all the advantages of short stem designs, it remains unclear whether they are able to limit post-surgical thigh pain. In patients with short stem hip arthroplasty and persistent thigh pain, it is of the utmost importance to understand the potential etiologies of this chronic pain for selecting the appropriate treatment strategy. Therefore, this manuscript explores the hypothetical etiologies of persisten…
Central pain processing in patients with shoulder pain : a review of the literature
Background Shoulder pain is a common health problem in which changes in shoulder structure cannot always explain the patient's perceived pain. Central sensitization (CS) might play a role in a subgroup of these patients. Methods The literature was systematically reviewed to address the role of CS in patients with shoulder pain. Electronic databases PubMed and Web of Knowledge were searched for relevant studies. Results Eighteen full-text articles were included, methodological quality was scored, and information was extracted. Studies were clustered on those studying patients with musculoskeletal (MSK) shoulder pain and those studying patients with hemiplegic shoulder pain (HSP). In particul…
Conditioned Pain Modulation Is Not Impaired in Individuals with Frozen Shoulder: A Case-Control Study
Frozen shoulder (FS) is a poorly understood condition resulting in substantial shoulder pain and mobility deficits. The mechanisms behind FS are not yet fully understood, but, similar to other persistent pain states, central pain mechanisms may contribute to ongoing symptoms in this population. The objective of this research was to investigate conditioned pain modulation (CPM) in people with FS compared with pain-free individuals. A total of 64 individuals with FS and 64 healthy volunteers participated in this cross-sectional study. CPM was assessed by using the pressure pain threshold (PPT) and an occlusion cuff (tourniquet test) as the test and conditioning stimulus, respectively. The abs…
Inter- and intrarater reliability of two proprioception tests using clinical applicable measurement tools in subjects with and without knee osteoarthritis.
Abstract Background The therapeutic value of proprioceptive-based exercises in knee osteoarthritis (KOA) management warrants investigation of proprioceptive testing methods easily accessible in clinical practice. Objective To estimate inter- and intrarater reliability of the knee joint position sense (KJPS) test and knee force sense (KFS) test in subjects with and without KOA. Design Cross-sectional test-retest design. Method Two blinded raters performed independently repeated measures of the KJPS and KFS test, using an analogue inclinometer and handheld dynamometer, respectively, in eight KOA patients (12 symptomatic knees) and 26 healthy controls (52 asymptomatic knees). Intraclass correl…
Specific versus non-specific exercises for chronic neck or shoulder pain : a systematic review
The current systematic review aimed to compare the effect of injury-focused (specific) exercises versus more general (non-specific) exercises on pain in patients with chronic neck or shoulder pain. We searched PubMed, EMBASE, and Web of Science. Two reviewers screened and selected studies, extracted outcomes, assessed risk of bias, and rated the quality of evidence. A total of nine eligible studies, represented in 13 articles, were identified, with a considerable risk of bias. One article investigated the acute effect of single bouts of exercise on pain and reported an immediate pain reduction after non-specific exercise. Regarding short-term effects, seven out of the nine studies found no …
A manual therapy and home stretching program in patients with primary frozen shoulder contracture syndrome : a case series
Abstract: Background Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. The purpose of this case series was to describe both short and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. Case Description Eleven patients with primary FSCS were treated with an individually tailored multimodal manual therapy approach once weekly for 12 visits coupled with home stretching exercises once a day, five days pe…
The shoulder medial rotation test: an intertester and intratester reliability study in overhead athletes with chronic shoulder pain.
The purpose of this study was to examine intertester and intratester reliability of the shoulder medial rotation test (MRT) and reliability differences depending on examiner expertise.Seventeen athletes with chronic shoulder pain participated in the study. Four independent observers with different experience levels simultaneously rated MRT performance as "correct" or "incorrect," after a standardized assessment protocol, the same day (for intertester reliability) and in a 7-day interval (for intratester reliability).The intrarater reliability was admissible for 2 experts and one novice, with κ values ranging between 0.32 to 0.76 and poor for one novice (κ0). Interrater agreement for all 4 a…
An Instrument-Assisted coracoid pain test: an exploratory diagnostic accuracy study
The coracoid pain test (CPT) could contribute to the diagnosis of frozen shoulder (FS) with palpation. However, due to assessor performance these values might be unreliable. Therefore, the aim was to explore the diagnostic accuracy of an instrument-assisted CPT and two alternative approaches (pain severity and side comparison) for assistance in the diagnosis of FS. Patients with FS and healthy age-matched controls were recruited. All participants underwent the instrument-assisted CPT on both shoulders with a pressure algometer. Sensitivity, specificity, and likelihood ratios were determined for the three approaches. In total, 35 patients with FS and 35 healthy participants were included. Th…
Prevalence, incidence, localization, and pathophysiology of myofascial trigger points in patients with spinal pain : a systematic literature review
Abstract Objective A systematic review was performed to evaluate the existing evidence related to the prevalence, incidence, localization, and pathophysiology of myofascial trigger points (MTrPs) in patients with spinal (back and neck) pain. Methods A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in 2 electronic databases (PubMed and Web of Science) using predefined keywords regarding MTrPs and spinal pain. A “PICOS” questionnaire was used to set up the search strategies and inclusion criteria. Full-text reports concerning MTrPs in patients with back or neck pain, which described their prevalence, incidence, location,…
Applying Modern Pain Neuroscience in Clinical Practice: Criteria for the Classification of Central Sensitization Pain
Background: The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists. Objectives: Designing the first set of classification criteria for the classification of central sensitization pain. Methods: A body of evidence from original research papers was used by 18 pain experts from 7 different countries to design the first classification criteria for central sensitization pain. Results: It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differentia…