Search Results (29)

Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio–humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07228455. Full article

Objectives: The aim of this systematic review was to evaluate the effectiveness of thoracic manual therapy with or without exercise for improving clinical outcomes (pain, disability, range of motion (ROM), quality of life (QoL) and satisfaction) in patients with subacromial pain syndrome (SPS). Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) involving thoracic manual therapy with or without thoracic exercise for patients with SPS were included. Databases searched included PubMed, PEDro, Cochrane Library, and Web of Science up to April 2025. The methodological quality was evaluated with the PEDro scale. Results: Seven RCTs involving 393 patients were included. Interventions ranged from thoracic manipulation alone to combinations with exercises. Better outcomes were reported for every clinical outcome evaluated: pain, disability, ROM, QoL and satisfaction. However, methodological heterogeneity and variability in follow-up durations limited result generalizability. Conclusions: Thoracic manual therapy applied in isolation or with exercise was reported to have positive effects in reducing pain and disability in patients with SPS, especially in the short term. These findings support the inclusion of thoracic interventions as complementary strategies in shoulder rehabilitation programs. Future high-quality trials with long-term follow-up are needed to confirm and standardize these approaches. Full article

Background: Subacromial impingement or pain syndrome (SAPS) is the most common diagnosis for chronic shoulder pain. Current surgeries do not reduce long-term pain, suggesting they miss the root etiology. Previously, we described the Human Disharmony Loop (HDL), where the unique lower trunk innervation to the pectoralis minor (PM) causes scapular dyskinesis and deforms its connections, including tugging the acromion down and impinging the subacromial structures. We hypothesize that SAPS patients who meet HDL criteria would benefit significantly from PM tenotomy with infraclavicular brachial plexus neurolysis (PM + ICN) alone. Methods: SAPS patients who met HDL diagnostic criteria were treated with PM + ICN, with secondary distal neurolysis if needed. Outcomes included pain and shoulder abduction ROM. Six-month follow-up minimum was required. Results: N = 140 patients were included. Median age was 49. Prior surgeries included 27% subacromial decompression/acromioplasty, 21% rotator cuff repair, 16% biceps tenodesis, 4% SLAP repair, 2% labral repair, 7% distal clavicle resection, 10% reverse total shoulder arthroplasty (rTSA), 1% rib resection with scalenectomy, 16% cervical spine fusion, 28% distal neurolysis. Median pain decreased from 8 to 2 and median shoulder ROM increased from 90 to 180 degrees. Positive impingement signs on exam decreased from 100% to 11%. (p < 0.01) Conclusions: In a large series of SAPS patients, evaluation and treatment for the HDL significantly reduced pain and restored motion. These findings suggest that in many patients SAPS may be a subset of the HDL: the ventral PM disturbing the scapula constitutes the anatomic basis and optimal surgical target behind SAPS. Full article

Background and Objectives: CrossFit is a discipline involving a wide range of overhead movements performed at high intensity and under accumulated fatigue that predispose to a high risk of shoulder complex injuries. This study aimed to compare ultrasonographic findings between symptomatic and asymptomatic shoulders in CrossFit athletes. Materials and Methods: A cross-sectional study was conducted to compare ultrasound parameters between the painful and non-painful shoulders in CrossFit athletes with unilateral subacromial shoulder pain. Assessed variables included subacromial subdeltoid bursa thickness, supraspinatus tendon thickness, the acromiohumeral distance, the coracoacromial ligament distance, the bicipital groove angle, cross-sectional area of the biceps brachii longus head tendon, as well as the serratus anterior and lower trapezius muscle thickness. Results: Twenty male CrossFit athletes (forty shoulders) with an average age of 25.70 ± 4.03 years participated in the study. A statistically significant increase was observed (p < 0.05) in the subacromial subdeltoid bursa thickness in the painful shoulder compared to the asymptomatic side. All other ultrasound parameters did not show statistically significant differences. Conclusions: Only subacromial subdeltoid bursa thickness differed significantly between sides. This isolated finding may not fully explain shoulder pain, which cannot be solely attributed to morphological changes. Further research is needed to determine the relationship between shoulder pain and ultrasound features in CrossFit athletes, as well as the role of ultrasound in predicting structural changes in pain conditions. Full article

Background: Chronic shoulder pain is a prevalent musculoskeletal disorder often associated with central sensitisation, which limits the effectiveness of conventional therapies. Transcranial direct current stimulation (tDCS) has emerged as a non-invasive neuromodulatory intervention to modulate cortical excitability and potentially improve pain and functional outcomes. Methods: This scoping review followed the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic search was conducted across MEDLINE, CENTRAL, Scopus, PEDro, and Web of Science to identify studies evaluating the effects of tDCS on pain and function in adults with rotator cuff disorders, myofascial pain syndrome (MPS), or subacromial pain syndrome (SAPS). Data were extracted and synthesised qualitatively. Results: Four studies met the inclusion criteria. tDCS demonstrated variable efficacy: some trials reported no additional benefit when used alongside corticosteroid injections or sensorimotor training (e.g., SAPS and rotator cuff tendinopathy), while others showed enhanced pain reduction and functional gains, particularly in MPS. Targeting the dorsolateral prefrontal cortex (DLPFC) appeared more effective than stimulating the primary motor cortex (M1) in modulating pain. Functional improvements were generally observed, though not consistently superior to sham interventions. Conclusions: Preliminary evidence suggests that tDCS may represent a promising adjunctive treatment for chronic shoulder pain, particularly in MPS. However, due to the limited number of studies and heterogeneity in methods, conclusions should be interpreted with caution. However, heterogeneity in study protocols, stimulation targets, and patient populations limits conclusive recommendations. Standardised protocols and larger trials are needed to determine the optimal application of tDCS in clinical shoulder pain management. Full article

Introduction. Compared to pain, weakness, and stiffness, snapping phenomena are less frequently reported. The anatomical implication of subacromial bursa on snapping syndrome has not yet been studied despite of the fact that subacromial volume is implicated in this syndrome. The aim of this study is to analyze the anatomical and dynamic implication of the subacromial bursa in snapping syndrome. Methods. We conducted a retrospective of symptomatic case series (n = 9) study including dynamic sonography, video recordings resulting from standardized clinical dynamic examinations, and the results of shoulder magnetic resonance imaging. Nine patients complaining of snapping phenomena of the anterior shoulder (seven males and two females, mean age: 37.1 ± 10.2 years old), in whom dynamic sonography could confirm the diagnosis of snapping subacromial bursa, were included in this study. Results. All the patients included in this study presented non-traumatic painful snapping syndrome without plication before the snap on the dynamic sonography. All complained of a disabling snap of the shoulder associated with pain and without folding before the snapping phenomenon. Four of them had a bursitis of the subacromial bursa diagnosed on their shoulder’s magnetic resonance imagery. No significant statistical correlation (rS = −0.372; p = 0.595) was found between the triggering mechanisms, such as the snap shoulder release position, and the position of the anterior recess of the subacromial bursa relative to the biceps’ tendon. Conclusions. This study highlights the anterior recess of the subacromial bursa as a previously underexplored anatomical contributor to snapping syndrome, particularly in young, physically active individuals, emphasizing the need for dynamic sonography in diagnosing this condition. The anterior recess of the subacromial bursa represents an additional cause of snapping, which especially takes place in young and physically active patients. More than sport practice, professional activities that require repetitive tasks of the shoulder seem to represent a risk factor. Full article

Background/Objectives: Many patients evaluated by shoulder specialists suffer from intractable pain, neuropathy, and weakness. The pectoralis minor (PM) remains the only scapula muscle to receive lower trunk (C8-T1) input. We propose a novel syndrome: the Human Disharmony Loop. This model portrays how this unique PM innervation causes scapular dyskinesia, which deranges the anatomy of the upper limb girdle and produces a refractory symptom complex of pain, neuropathy, and weakness. We hypothesize that certain patients with historically intractable symptoms of the upper limb girdle may benefit from PM tenotomy. Methods: Ten patients of diverse etiologies presented with a similar constellation of complaints. The patients included a female athlete, a female with macromastia, a male bodybuilder, and patients with post-radiation breast cancer, post-operative shoulder arthroplasty, interscalene block injury, cervical spine disease, persistent impingement after rotator cuff repair, direct traction injury, and occupational disorder. All patients exhibited coracoid tenderness, scapula protraction with internal rotation and anterior tilt, and pain involving the neck, shoulder, and upper back. The patients demonstrated varying degrees of arm neuropathy, subacromial impingement, and occipital headaches. The patients failed all prior treatments by multiple subspecialists, including surgery. Each patient underwent isolated open PM tenotomy. Results: In all ten patients, PM tenotomy substantially reduced shoulder, upper back, and neck pain, cleared concomitant neuropathy, restored full motion, and eradicated occipital headaches. The response to surgery was rapid, dramatic, and durable. Conclusions: The unique asymmetric neurologic innervation to the sole ventral stabilizer of the scapula, the pectoralis minor, predisposes the human shoulder to neurologic and musculoskeletal imbalance. This produces the Human Disharmony Loop: a clinical syndrome spanning from the neck to the fingertips, with chronic pain, neuropathy, and weakness. These challenging patients may benefit dramatically from isolated PM tenotomy. Full article

Background/Objectives: Shoulder pain is a common treatment outcome in breast cancer survivors. While various risk factors and mechanisms for shoulder pain have been proposed, evidence is inconsistent. Increased risk of subacromial pain syndrome exists, which can lead to disability and reduced quality of life if untreated. Ultrasound is a valuable tool for detecting rotator cuff changes aiding in timely diagnosis of subacromial pain syndrome. This study aimed to assess the prevalence of rotator cuff changes to better understand chronic shoulder pain in breast cancer survivors. Methods: This cross-sectional study included 74 breast cancer survivors from the University Hospital Split. Data were collected via questionnaires and clinical interviews. Bilateral shoulder ultrasounds were performed by two blinded investigators. Categorical variables were analyzed using Chi-squared tests, and continuous variables were analyzed with T-tests or Mann–Whitney tests. Results: Pathological findings were similarly prevalent on the operated and non-operated sides (p = 0.3 and p = 0.6). Among participants with shoulder pain, ultrasound-detected pathology was present in 91% of right shoulders and 96% of left shoulders (p < 0.005). Non-painful shoulders exhibited pathology in 59% of right and 57% of left shoulders. Ipsilateral pain to the site of breast surgery was reported by 57.7% of participants, with supraspinatus pathology in 56%, acromioclavicular joint pathology in 39%, and subacromial–subdeltoid bursitis in 41%. Conclusions: Similar pathology distribution on operated and non-operated sides and frequent asymptomatic findings highlight unresolved causes of shoulder pain in breast cancer survivors. Ultrasound is valuable but requires integration with clinics for accurate diagnosis of the underlying causes of shoulder pain. Full article

Background: This study assessed Transcutaneous Pulse Radiofrequency Therapy’s (TCPRF) effectiveness in reducing shoulder pain and improving shoulder function. Methods: A double-blind randomized controlled trial involved 50 SAIS patients with chronic shoulder pain. Participants were randomized into two groups: the study group (n = 27) received TCPRF, while the control (n = 23) received sham treatment. The primary outcome was shoulder pain, secondary outcomes, including shoulder function, quality of life, and range of motion, were assessed at baseline, and at 1, 4, and 12 weeks using the Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI), and the SF-36 questionnaire. Supraspinatus tendon thickness (SSPT) and acromiohumeral distance (AHD) were measured by ultrasound. Results: Both groups showed reductions in activity and resting pain over 12 weeks. In the control, activity pain dropped from a median (IQR) of 8 (7–8) to 6 (3–7), and in TCPRF from 8 (7–10) to 3.5 (2–6.3), with no significant difference at 12 weeks (p = 0.192). Resting pain decreased from 3 (1–6) to 1 (1–3) in the control, and from 3 (2–4) to 0 (0–2) in TCPRF, showing a lower resting pain at 12 weeks (p = 0.041). SPADI-Total scores decreased from 87 (54–105) to 50 (29–82) in the control and from 84 (69–107) to 21 (9–66.3) in TCPRF, favoring TCPRF at 12 weeks (p = 0.017). SPADI–Disability scores reduced from 49 (30–63) to 30 (15–30) in control and from 47 (35–62) to 11 (5.8–38.8) in TCPRF, also favoring TCPRF (p = 0.008). Both groups showed similar improvements in other outcomes. Conclusions: TCPRF reduced resting pain and shoulder disability in SAIS over 12 weeks, though other outcomes showed similar improvement in both groups. Further studies are needed to determine long-term effects. Full article

Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results: The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n²_p = 0.011; anxiety: F = 0.780, p = 0.463, n²_p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n²_p = 0.02; or sleep quality: F = 0.294, p = 0.747, n²_p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ −1.2, 95%CI −2.3 to −0.1) or the placebo (Δ −1.3, 95%CI −2.5 to −0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment. Full article

This study aimed to investigate the efficacy of manual therapy and exercise versus synchronized telerehabilitation with self-manual therapy and exercise in treating Subacromial Pain Syndrome (SAPS). Sixty individuals diagnosed with SPS, aged 18–50 years, were randomly assigned to home exercise (HE), manual therapy (MT), and telerehabilitation (TR) groups. Treatment protocols were administered over 8 weeks and included specific exercises and therapy interventions. Outcome measures included the Visual Pain Scale (VAS), shoulder range of motion (ROM) via goniometric measurements, Quick Disability Arm-Shoulder-Hand Problems Survey (Q-DASH), and patient satisfaction. Results revealed that both MT and TR groups exhibited reduced pain, increased ROM, lower Q-DASH scores, and higher patient satisfaction than the HE group. However, no significant differences were found between the MT and TR groups regarding pain levels, ROM, Q-DASH scores, or patient satisfaction. The study concludes that both telerehabilitation and manual therapy effectively alleviate pain and are well-received by patients with SPS. Additionally, manual therapy demonstrates superiority in enhancing functional levels compared to exercise-based interventions (Registration: NCT05200130). Full article

Background: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions. Methods: Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed. Results: A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) −0.244; 95% CI, −1.232 to 0.745; I², 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, −0.413 to 1.921; I², 90.2%) and 3 months (WMD−0.089; 95% CI, −0.345 to 0.166; I², 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups. Conclusion: NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis. Full article

Diacutaneous Fibrolysis (DF) is an instrumentally assisted manual therapy technique defined as “a specific instrumental intervention for normalizing the musculoskeletal system function after a precise diagnosis and preserving the skin’s integrity”. The aim of this technique is soft tissue mobilization with the assistance of specially designed, hook-shaped steel instruments in different musculoskeletal structures, such as the myofascia, aponeurosis, tendons, ligaments and scar tissues. Due to discrepant results between previous reviews and the quite abundant new evidence provided by recently published randomized clinical trials, we propound this narrative review to provide an update on the scientific evidence related to the fundamentals and clinical efficacy of DF. Current evidence primarily supports the mechanical effect of DF on connective soft tissues. Diminished deep tendon reflex and rigidity have been registered after the implementation of DF in healthy subjects. Though there is still much to uncover, scientific evidence supports the use of the technique for the clinical treatment of subacromial impingement syndrome, chronic lateral epicondylalgia, chronic patellofemoral pain syndrome, mild to moderate carpal tunnel syndrome, hamstring shortening, temporomandibular disorders, tension-type headache and chronic low back pain. Additional data are essential for better recommendations in the clinical practice of DF. Full article

Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain in adults and is caused by muscle imbalance around the shoulder joint, which is referred to as secondary SIS. Centralization of the glenohumeral joint (CGH), one of the intervention methods for this, targets strengthening the control ability of the rotator cuff. Dynamic humeral centering (DHC) targets the learning of selective contractile function of the pectoralis major and latissimus dorsi as depressors of the humeral head. This study aims to determine the short-term effects of CGH and DHC on pain, disability, and grip strength in patients with secondary SIS. Forty-eight patients with secondary SIS participated in the study and were randomly allocated into three groups (CGH group (n = 16), DHC group (n = 16), and simple exercise group (n = 16)) and received the intervention for 50 min. The Constant–Murley score was used to assess shoulder pain and disability (primary outcome), and a hand-held dynamometer was used to assess grip strength (secondary outcome). Measurements were performed before the intervention and one day after the intervention. The results showed that the Constant–Murley score improved in the CGH and DHC groups. In addition, pain and disability (range of motion scores) improved in both the CGH and DHC groups. Improvements in disability (shoulder strength) and grip strength were seen only in the CGH group. Both CGH and DHC can be used as methods for short-term pain release and disability recovery in secondary SIS. In particular, CGH appears to be more effective in the short-term improvement in shoulder strength and grip strength. Full article

Sub-acromial Impingement Syndrome (SIS) is a prevalent shoulder pathology characterized by pain, muscle weakness, and altered joint position sense (JPS). This prospective study aimed to comprehensively assess the relationship between shoulder muscle strength, JPS, and pain in individuals with SIS. A total of 100 participants, including 50 with SIS and 50 healthy controls, underwent shoulder muscle strength testing and JPS evaluation in various directions (flexion, abduction, medial rotation, and lateral rotation). Pain intensity was quantified using a visual analog scale. Correlation analyses were conducted to explore the associations between muscle strength, JPS, and pain, with Cohen’s d values indicating the effect size. Individuals with SIS exhibited significantly lower shoulder muscle strength and greater JPS errors compared to the healthy controls (p < 0.001, Cohen’s d = 0.51 to 0.84). The results showed strong positive correlations between muscle strength and JPS in all assessed directions (p < 0.001, with r values ranging from 0.35 to 0.62). Mediation analysis revealed that pain partially mediated the relationship between muscle strength and JPS in all directions (p < 0.005). This study highlights the multifaceted nature of SIS, emphasizing the coexistence of muscle weakness, proprioceptive impairments, and pain. The findings underscore the importance of addressing these factors in the comprehensive rehabilitation of individuals with SIS to optimize functional outcomes and enhance their quality of life. Full article