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Federico Jose Villalba and Melina Soledad Martínez

Key Points ▸ The global incidence of sternoclavicular injuries is lower than 1%. ▸ There are no therapeutic approaches or rehabilitation protocols established for this condition. ▸ A treatment based on exercises and education improved subjective and objective measurements. Shoulder pain is the

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Kyle Matsel, Claire Davies and Tim Uhl

Clinical Scenario Shoulder pain is the third most commonly encountered musculoskeletal condition in orthopedic physical therapy practice, behind only neck and low-back pain. 1 Shoulder pain accounts for approximately 14% to 21% of all musculoskeletal visits, and the estimated costs approach 7

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Fábio Carlos Lucas de Oliveira, Amanda L. Ager and Jean-Sébastien Roy

-related shoulder pain (RCRSP). In addition, scapular kinematic alterations, such as a limited posterior tilt and upward scapular rotation, have been demonstrated to favor the narrowing of the subacromial space and, consequently, the AHD reduction. 8 Therefore, these alterations in the scapular motion, frequently

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Kathleen A. Swanik, C. Buz Swanik, Scott M. Lephart and Kellie Huxel

Objective:

To determine whether functional training reduces the incidence of shoulder pain and increases strength in intercollegiate swimmers.

Design:

Pretest–posttest.

Setting:

Laboratory and weight room.

Participants:

26 intercollegiate swimmers (13 men, 13 women).

Intervention:

6-wk functional training program.

Main Outcome Measures:

Incidence of shoulder pain was recorded throughout the study. Isokinetic shoulder strength was assessed before and after training.

Results:

A t test showed significant differences (P < .05) for the incidence of shoulder pain between the experimental (mean episodes = 1.8 ± 2.1) and control (mean episodes = 4.6 ± 4.7) groups. ANOVA with repeated measures revealed no significant strength differences between groups but exhibited significant within-group increases.

Conclusions:

Incorporating functional exercises might reduce incidence of shoulder pain in swimmers. The results also validate the need to modify preventive programs as the demands of the sport change throughout the season.

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Fahimeh Kamali, Ehsan Sinaei and Maryam Morovati

Shoulder pain is among the most common musculoskeletal disorders in overhead athletes such as throwers, swimmers, and tennis, baseball and volleyball players. Repetitive overhead throwing motions, altered movement patterns of the shoulder, scapular dyskinesis, insufficient rotator cuff performance

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Katherine Craig, Shannon L. Jordan, Daniel R. Chilek, Doug Boatwright and Julio Morales

numbness was resolved and shoulder pain had decreased to 2/10. The athlete continued the rehabilitation program and began passing a limited number of volleyballs in the gym. Overhead hitting was postponed until week 12, after ROM had been regained. At 10 weeks, resistance was increased and participation in

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Shana Harrington, Corinne Meisel and Angela Tate

Context:

The prevalence of shoulder pain in the competitive swimming population has been reported to be as high as 91%. Female collegiate swimmers have a reported shoulder-injury rate 3 times greater than their male counterparts. There has been little information on how to best prevent shoulder pain in this population. The purpose of this study was to examine if differences exist in shoulder range of motion, upper-extremity strength, core endurance, and pectoralis minor length in NCAA Division I female swimmers with and without shoulder pain and disability.

Methods:

NCAA Division I females (N = 37) currently swimming completed a brief survey that included the pain subscale of the Penn Shoulder Score (PSS) and the sports/performing arts module of the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure. Passive range of motion for shoulder internal rotation (IR) and external rotation (ER) at 90° abduction was measured using a digital inclinometer. Strength was measured using a handheld dynamometer for scapular depression and adduction, scapular adduction, IR, and ER. Core endurance was assessed using the side-bridge and prone-bridge tests. Pectoralis minor muscle length was assessed in both a resting and a stretched position using the PALM palpation meter. All measures were taken on the dominant and nondominant arms.

Results:

Participants were classified as positive for pain and disability if the following 2 criteria were met: The DASH sports module score was >6/20 points and the PSS strenuous pain score was ≥4/10. If these criteria were not met, participants were classified as negative for pain and disability. Significant differences were found between the 2 groups on the dominant side for pectoralis muscle length at rest (P = .003) and stretch (P = .029).

Conclusions:

The results provide preliminary evidence regarding an association between a decrease in pectoralis minor length and shoulder pain and disability in Division I female swimmers.

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Enrique V. Smith-Forbes, Stephanie D. Moore-Reed, Philip M. Westgate, W. Ben Kibler and Tim L. Uhl

Context:

Recent establishment of G-codes by the US government requires therapists to report function limitations at initial evaluation. Limited information exists specific to the most common limitations in patients with shoulder pain.

Objective:

To describe the most commonly expressed shoulder limitations with activities and their severity/level of impairment from a patient’s perspective on the initial evaluation.

Design:

Descriptive.

Setting:

Patients reporting pain with overhead activity and seeking medical attention from one orthopedic surgeon were recruited as part of a cohort study.

Patients:

176 with shoulder superior labral tear from anterior to posterior (SLAP), subacromial impingement, combined SLAP and rotator cuff, and nonspecific (female = 53, age = 41 ± 13 y; male = 123, age = 41 ± 12 y).

Interventions:

Data were obtained on the initial visit from the Patient-Specific Functional Scale (PSFS) questionnaire. Three researchers extracted meaningful concepts from the PSFS and linked them to the International Classification of Functioning (ICF) categories according to established ICF linking rules.

Results:

176 participants yielded 765 meaningful concepts that were linked to the ICF with a 66% agreement between researchers before consensus. There were no differences between diagnoses. Of all patients, 88% reported functional limitations coded into meaningful concepts as represented by 10 ICF codes; 634 (83%) meaningful concepts were linked to the activities and participation domain while 129 (17%) were linked to the body function domain. Only 2 reported functional limitations that were considered nondefinable (nd). The overall average initial impairment score on the PSFS = 4 ± 2.5 out of 10 points.

Conclusion:

Meaningful concepts from the activities and participation domain were most commonly identified as functional limitations and were more prevalent than limitations from the body function domain. This information helps identify some of the most common limitations in patients with shoulder pain that therapists can use to efficiently document patient functional impairment.

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Lori A. Michener, Alison R. Snyder and Brian G. Leggin

Context:

The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices.

Objective:

To determine the minimal clinically important difference (MCID) of the NPRS.

Design:

Single-group repeated measures.

Setting:

Outpatient rehabilitation clinics.

Patients:

Patients with shoulder pain (N = 136).

Main Outcome Measures:

At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3–4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0–60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen’s effect sizes were calculated as a measure of group responsiveness for the NPRS average.

Results:

Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74–.76 (95%CI: .55–.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively.

Conclusions:

The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3–4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.

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Aimee L. Thornton, Cailee W. McCarty and Mollie-Jean Burgess

Clinical Scenario:

Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM).3 Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear.

Focused Clinical Question:

Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?