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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We compared the short-term efficacy and safety of intra-articular (IA) botulinum toxin A (BoNT/A) to IA-placebo in patients with chronic, refractory shoulder joint pain. Forty-three shoulder joints in patients with moderate-to-severe shoulder arthritis pain were randomized to receive (1) 100 units IA-BoNT/A + lidocaine or (2) IA-saline + lidocaine. The following outcomes were compared using analysis of covariance: (1) primary: change in pain severity on a visual analog scale at 1 month (VAS, 0 cm to 10 cm); (2) secondary: Shoulder Pain and Disability Index (SPADI) disability subscale, quality of life on short-form (SF)-36 subscales, percent of patients who achieved at least a 30% decrease or a 2-point reduction in VAS pain (clinically meaningful pain relief), and safety. Both BoNT/A (n = 21) and placebo (n = 22) groups were comparable at baseline. At 1 month post-injection, the VAS pain reduction was significantly more in the BoNT/A group versus the placebo group (-2.4 vs -0.8; P-value = 0.014). When comparing BoNT/A with the placebo group at 1 month, it was observed that 5 SF-36 subscale scores improved significantly (P </= 0.035), and the SPADI disability improved more with a trend toward significance (51.5 +/- 4.4 vs 64.9 +/- 3.9; P = 0.083). In addition, clinically meaningful pain relief occurred in 61% versus 36% patients (P = 0.22). The total number of adverse events was similar, which included 50 events in the BoNT/A group versus 46 events in the placebo group. A single injection of BoNT/A produced statistically significant and clinically meaningful pain relief and improvement in quality of life in patients with chronic refractory moderate/severe shoulder arthritis pain at 1 month. These data provide evidence to support the efficacy of this novel neurotoxin therapy that needs to be confirmed in a multicenter, randomized trial.
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PMID:Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial. 1937 81

Acupuncture is increasingly used as an alternative or complementary therapy for the treatment of pain. It is well tolerated, with a low risk of serious adverse effects. Traditional and modern acupuncture techniques may result in reported improvement in pain patterns. Research on acupuncture has had a number of limitations, including: incomplete understanding of the physiologic effects of acupuncture; ineffective blinding of participants; unclear adequacy of acupuncture "dose;" difficulty in identification of suitable sham or placebo treatments; and the use of standardized treatment regimens rather than the individualized approach that characterizes most acupuncture practice. Controlled trials have been published regarding acupuncture for lumbar, shoulder, and neck pain; headache; arthritis; fibromyalgia; temporomandibular joint pain; and other pain syndromes. Enough data are available for some conditions to allow systematic evaluations or meta-analyses. Based on published evidence, acupuncture is most likely to benefit patients with low back pain, neck pain, chronic idiopathic or tension headache, migraine, and knee osteoarthritis. Promising but less definitive data exist for shoulder pain, fibromyalgia, temporomandibular joint pain, and postoperative pain. Acupuncture has not been proven to improve pain from rheumatoid arthritis. For other pain conditions, there is not enough evidence to draw conclusions.
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PMID:Acupuncture for pain. 2094 79

Some of the most common presentations in a primary care office relate to shoulder pain; disorders of the rotator cuff and potential look-alikes such as referred neck pain or acromioclavicular (AC) joint arthritis are chief among the causes. The differential diagnosis can be difficult, particularly among older patients. And, of course, patients want relief of pain. Subacromial space injection using anesthetic with or without corticosteroid can assist in both phases of management.
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PMID:Subacromial space injection: pain reliever, diagnostic tool. 2008 15

Twenty male patients who were attending an occupational health care center because of prolonged (more than three months) shoulder pain were subjected to extensive rheumatological and laboratory examinations. Ergonomic and anthropometric data were compared with those of matched referents. Inflammatory rheumatic diseases were diagnosed for three patients (rheumatoid arthritis for one and reactive arthritis to urinary infections for two). No definite diagnosis was possible with regard to the other 17 patients. Their ages were significantly higher than the mean age of workers at their respective factories and that of industrial workers in Sweden. The anthropometric measurements for these patients did not differ from those of the matched referents or from other Swedish males of the same age. Shoulder load, estimated as work with hands at or above acromion height, was significantly heavier among the patient group than among the referents. Neither the evaluated physical load of their current work nor previous hard work was found to be a significant factor. A follow-up two years later showed a definite deterioration, the majority being on pension or still on sick leave.
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PMID:Clinical and ergonomic factors in prolonged shoulder pain among industrial workers. 2012 May 68

This article evaluates the effectiveness of the external rotation test in diagnosing capsulitis. The test is performed with the upper arm in a neutral position at the patient's side and the elbow in 90 degrees of flexion. The test is positive when pain is produced with this maneuver. All patients (379) evaluated for atraumatic shoulder pain during 1 calendar year were studied. The patients were divided into external rotation positive (91 patients) and external rotation negative (311 patients) groups. Patients with atraumatic shoulder pain with a positive external rotation test were presumed to have adhesive capsulitis in the absence of glenohumeral arthritis. Patients diagnosed with adhesive capsulitis received an intra-articular steroid injection and a home therapy program. Patients were contacted 10 to 19 months following treatment to determine their status and need for any further care. A diagnosis of adhesive capsulitis was made in 75% of external rotation positive patients (68 patients). Glenohumeral arthritis evidenced by radiographs was the only other diagnosis that produced a positive external rotation test (23 patients) in this group of atraumatic shoulders. Only 1 of 68 patients (1.4%) with a diagnosis of adhesive capsulitis (external rotation positive) had surgery during the follow-up period. However, 86 of 311 (27.7%) patients in the external rotation negative group underwent surgery (P<.0001). In the external rotation positive group, 3 patients (5%) sought second opinions, while 95% (55/58) sought no further care. Our data suggest that patients with a history of atraumatic shoulder pain and a positive external rotation test on examination should be considered for adhesive capsulitis in the absence of glenohumeral arthritis.
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PMID:The external rotation test in the diagnosis of adhesive capsulitis. 2050 51

Shoulder pain is a frequent clinical problem facing primary care physicians. Despite its common occurrence, many clinicians are unfamiliar with the diagnosis and treatment of many common shoulder ailments. Because therapy for most shoulder disorders can be made at the initial consultation, a good history and physical remain paramount. The purpose of this paper is to review the basic approach to diagnosis and management of shoulder pain. It will summarize a pragmatic approach to the initial history, with particular attention to differentiating extrinsic and intrinsic etiologies. Physical exam techniques for evaluating shoulder pain will be reviewed, including provocation testing for specific disorders. Specific disorders covered include supraspinatus tendonitis, subdeltoid bursitis, frozen shoulder, biceps tendonitis, and acromioclavicular (AC) joint arthritis.
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PMID:Evaluation and management of shoulder pain in primary care clinics. 2089 Feb 50

Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive.
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PMID:Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain. 2124 Jan 57

One of the main causes of neuropathic osteoarthropathy of the shoulder is cervical syringomyelia. Chronic pain and swelling of the shoulder are the most frequent manifestations, but it occasionally can develop rapid osteoarticular destructive lesions (in less than six weeks), which raise the diagnostic possibility of septic arthritis and some tumours We present the report of two men with septic arthritis of the shoulder associated with neuropathic arthropathy secondary to syringomyelia. Both patients presented with sudden shoulder pain exacerbated by either passive or active joint movements, malaise and fever. The first patient, a 39-year-old man, suffered left shoulder arthritis due to Staphylococcus aureus. The second patient, a 59-year-old man presented with right shoulder arthritis caused by to Staphylococcus epidermidis. The last microorganism also was isolated in three blood cultures. Infection should certainly be considered as a possible complication of the natural history of the neuropathic shoulder.
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PMID:[Septic arthritis complicating neuropathic shoulder due to cervical syringomyelia]. 2179 89

Rotator cuff pathology is a common cause of shoulder pain, and imaging plays a major role in the management of shoulder problems. General radiography may be useful as an initial screening test particularly in trauma and arthritis. Musculoskeletal ultrasound and magnetic resonance imaging are the most suitable modalities for the investigation of the rotator cuff, having high sensitivities and specificities for full-thickness tears. Musculoskeletal ultrasound and magnetic resonance imaging are less accurate in the detection of partial-thickness tears with greater observer variability. This article reviews the normal and pathologic imaging features of the rotator cuff and highlights the potential usefulness and limitations of various imaging modalities in the assessment of the tendon and the potential impact of imaging findings on clinical patient care.
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PMID:Current imaging of the rotator cuff. 2182 12

We conducted a study to ascertain specific patterns of pain in patients with common shoulder disorders and to describe a comprehensive shoulder pain map. We prospectively studied 94 cases involving an upper limb pain map and correlated the maps with the final diagnoses made by 2 clinicians who were blinded to the pain map findings. Pattern, severity, and type of pain were specific to each common shoulder disorder. In subacromial impingement, pain was predominantly sharp, occurred around the anterior aspect of the shoulder, radiated down the arm, and was associated with dull, aching pain radiating to the hand. A similar pain pattern was found in rotator cuff tears. In acromioclavicular joint pathology, pain was sharp, stabbing, and well localized to the anterosuperior shoulder area. Glenohumeral joint arthritis was marked by the most severe pain, which occurred in a mixed pattern and affected the entire arm. Whereas the pain of instability was a mixture of sharp and dull pain, the pain of calcific tendonitis was severe and sharp. Both pains were limited to the upper arm and shoulder. Pain mapping revealed definitive patterns for shoulder pathologies. We advocate using pain maps as useful diagnostic guides and research tools.
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PMID:Pain mapping for common shoulder disorders. 2201 72


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