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186 patients with periarthritis of the shoulder have been studied. The sex ratio was female:male, 1-52:1. The peak age of onset was 54-59 years in both sexes. Over 40% of the patients were referred to the clinic after 6 months had elapsed from the time of onset of the disease. The right shoulder was more frequently involved than the left, particularly in the men. One shoulder only was affected in 75% of patients. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. There were a number of associated diseases, ischaemic heart disease, thyroid disease among women, diabetes among women, hemiplegia, pulmonary tuberculosis, chronic bronchitis, and epilepsy. Acute trauma was rarely a precipitating factor. Manual workers were more frequently seen than sedentary workers in the sample, and there were more in the sample than in the general population of Leeds. The general psychological background was no different from a control group. The Maudsley Personality Inventory gave no different results among patients with periarthritis of the shoulder than among a control group and among the general population. It is suggested that there is no evidence in this study for a 'periarthritic personality'. It is suggested that the cause of periarthritis of the shoulder is likely to be related to chronic trauma occurring in an age range when changes in connective tissue are occurring. Certain associated diseases may predispose the patient to this disorder.
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PMID:Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors. 98 1

A study was undertaken whereby a set of standardized (simulated) patients visited general practitioners without being detected, in a health care system where doctors had fixed patient lists. Thirty nine general practitioners were each visited during normal surgery hours by four standardized patients who were designed to be indistinguishable from real patients. The objective of the study was to see whether the actual performance of general practitioners, as assessed by standardized patients, met predetermined consensus standards of care for actual practice. The patients presented standardized accounts of headache, diarrhoea, shoulder pain and diabetes. The mean group scores of the doctors on the predefined standards of care for the different complaints ranged from 33 to 68%. The results show that standardized patients may be the method of choice in the assessment of the quality of actual care of doctors. It is hypothesized that the substandard scores of the doctors do not reflect inadequate competence, but are a result of the difference between competence and performance.
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PMID:Assessment of the performance of general practitioners by the use of standardized (simulated) patients. 193 Dec 15

Shoulder pain is a frequent and debilitating problem in hemiplegic patients, and its etiology remains poorly understood. The role played by hemineglect in the appearance of shoulder pain was studied. During two years, 94 hemiplegic subjects were involved in a rehabilitation program after cerebrovascular accidents. Their average age was 68 years; 45 (47.9%) subjects had shoulder pain, and 24 subjects (22.5%) had hemineglect. The subjects with shoulder pain were compared to those without pain (the control group) with respect to gender, age, diabetes, heart failure, cardiac ischemia, scapulohumeral arthritis, and calcified tendinitis of the rotator cuff. We were unable to demonstrate a relationship between hemineglect and shoulder pain in the hemiplegic (X2 (1) = 2.03, p = .15), although pain was significantly more frequent in subjects with right hemispheric cerebrovascular accident (X2 (1) = 5.0, p less than .025). The subjects with shoulder pain had significantly more spasticity of the affected limb (X2 (1) = 26.3, p less than .01), less sensitivity to pinprick of the upper paralyzed extremity (X2 (1) = 10.8, p less than .01), and a more severe subluxation of the affected shoulder (t(51) = 14.0, p less than .01).
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PMID:Painful shoulder in the hemiplegic and unilateral neglect. 237 73

Sixty diabetic patients with shoulder pain were followed in order to trace the natural history of the disease. The triad of painful shoulder, hand syndrome and restricted hip joint mobility was strongly correlated to the duration of diabetes and retinopathy. Painful shoulder with restricted mobility (58%) and tendinitis (28%) predominated. Hand syndrome was found in 62% and restricted hip joint mobility in 42%. Ninety percent of painful shoulders with restricted mobility had difficulties in the activities of daily living in the acute phase. There was functional limitation of shoulder mobility in 17% of painful shoulders with restricted mobility at the end of the study. The duration of diabetes and the duration of shoulder symptoms were correlated. In 25%, working capacity was affected by the painful shoulder. A serious risk of developing shoulder symptoms persisting for more than 2 years was associated with insulin treatment, diabetes lasting more than 10 years, proliferative retinopathy and painful shoulder with restricted mobility.
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PMID:The clinical picture of the painful diabetic shoulder--natural history, social consequences and analysis of concomitant hand syndrome. 243 41

Different types of shoulder affection were studied in 62 diabetic patients with shoulder pain. Three groups of shoulder joint disorder were found: painful shoulder with restricted mobility (62%), tendinitis without mobility restriction (27%), and a small group with mixed diagnoses. Sixty per cent had hand symptoms and 38% had restricted mobility of their hip joints. High frequencies of retinopathy and neuropathy were found. Affection of the shoulder joint was seen with almost the same frequency in insulin-dependent as in non-insulin-dependent patients, but after a shorter duration of diabetes in the latter. A group of patients with the triad shoulder pain, hand symptoms and restricted mobility of the hip joints had a significantly higher frequency of proliferative retinopathy than patients with shoulder pain only. The long duration of diabetes, the high frequency of insulin treatment and classical late complications indicate that diabetic patients with painful shoulder and restricted mobility are suffering from clinically advanced diabetes mellitus.
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PMID:The painful diabetic shoulder. 373 54

Sixty patients presenting consecutively with shoulder pain to a rheumatology clinic have been studied. There was a significant association of shoulder capsulitis with diabetes mellitus and antecedent trauma when compared with supraspinatus tendonitis (SST). There were no immunological or other biochemical differences between the capsulitis and SST patients. The results suggest that patients with shoulder capsulitis should be investigated to exclude diabetes mellitus particularly when there is no history of antecedent trauma.
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PMID:A comparative study of the aetiological factors in shoulder pain. 397 62

The association between periarthritis of the shoulder and diabetes mellitus is well recognized. A study of 100 hospitalized patients with diabetes was performed, comparing them with 100 control subjects. The mean +/- SEM age of the subjects was 47 +/- 2 yr. Nineteen percent of the patients with diabetes had periarthritis. The afflicted subjects had a higher incidence of retinopathy (P less than 0.005) and albuminuria (P less than 0.005). The duration of shoulder pain correlated with the duration of the diabetes mellitus (P less than 0.001). However, the presence of other complications in subjects with periarthritis was not as well correlated with the duration of the diabetes mellitus. These data emphasize the common occurrence of periarthritis in subjects with diabetes mellitus and its extension to people of diverse backgrounds.
Diabetes Care
PMID:Periarthritis: another duration-related complication of diabetes mellitus. 405 38

This self-directed learning module highlights new advances in the understanding of co-morbid conditions and medical complications of stroke. It is part of the chapter on stroke rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article covers co-morbid conditions of stroke patients, including cardiovascular disease, diabetes, and sleep apnea. It reviews recent information on complications of stroke, including deep venous thrombosis, dysphagia and aspiration, hospital-acquired infections, depression, falls, spasticity, shoulder pain, and seizures. Treatment advances in diabetes, depression, and spasticity are highlighted. Recent information is presented regarding exercise guidelines for the stroke patient with cardiovascular disease, the relationship between stroke and sleep apnea, prophylaxis of deep venous thrombosis, the changing spectrum of hospital-acquired infections, malnutrition in stroke patients, the problem of falls during rehabilitation, the evaluation and management of poststroke shoulder pain, and the risk of seizures after stroke.
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PMID:Stroke rehabilitation. 2. Co-morbidities and complications. 1032 98

We previously reported reliability and validity of our newly developed comorbidity scale (CS) for stroke outcome research based on a retrospective sample. The objectives of this study were to cross-validate the comorbidity scale in a new prospective sample and to investigate longitudinal changes of the comorbidity scale during hospitalization. In a prospective sample of 175 stroke patients admitted to five nonacute rehabilitation hospitals in Japan, we analyzed the frequency and grading of comorbidities and compared the comorbidity scale with demographic data, impairment as assessed with the Stroke Impairment Assessment Set (SIAS), and disability as measured with the Functional Independence Measure (FIM(SM)). The results were compared with our previous retrospective study. We also studied longitudinal changes by measuring the comorbidity scale on admission, 2 wk later, and at discharge of 67 patients. As a result, the comorbidity scaling was significantly lower in the prospective sample, and it increased at the second measurement and then plateaued. Among the comorbidities, hypertension ranked first, followed by shoulder pain, and diabetes mellitus. Similar to our previous retrospective study, the comorbidity scale correlated positively with age and length of stay and correlated negatively with the SIAS motor item scores and the FIM scores. In conclusion, the present study suggested concurrent and predictive validity of the comorbidity scale in a prospective sample as well and clarified the comorbidity characteristics of stroke inpatients.
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PMID:Comorbidities in stroke patients as assessed with a newly developed comorbidity scale. 1049 52

The index patient is a 23-year-old female with end-stage renal disease (ESRD) secondary to chemotherapeutic agents. Continuous cycling peritoneal dialysis (CCPD) has been the renal replacement therapy for the past 5 years since a failed cadaveric renal transplant. Past medical history was significant for diabetes mellitus, hypertension, anemia, bilateral subclavian vein thrombosis with superior vena cava syndrome, secondary hyperparathyroidism, leukemia (at age 8), and hyperlipidemia. On presentation, soft tissue nodules were noted in the anterolateral surfaces of the legs. After 3 months of continued low-calcium-dialysate CCPD, calcitriol, and oral phosphate binders, a 2 x 3 cm nodule was noted on the posterior aspect of the thorax at the scapula. The only complaint at this time was shoulder pain at the acromioclavicular joint. Radiological examination revealed a 3 x 4 cm soft tissue opacity in the superior segment of the left lower lobe laterally. Despite a prior subtotal parathyroidectomy, phosphate binders, and calcitriol, the parathyroid hormone levels continued to increase, with development of tumoral calcinosis, worsening renal osteodystrophy, and calciphylaxis. Computed tomography examination revealed extensive soft tissue calcification consistent with tumoral calcinosis. An ulcerative lesion (1 cm) developed on the lateral aspect of the upper thigh owing to warfarin necrosis versus calciphylaxis. At this time, the phosphate binder was changed from calcium acetate to sevelamer hydrochloride. Aggressive wound treatment and aggressive calcium and phosphate control added to the treatment regimen has resulted in healing of the single ulcer and a decrease in the size of the tumoral lesions. In conclusion, early recognition and aggressive treatment of calciphylaxis can result in reduced morbidity and mortality from calciphylaxis in ESRD patients.
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PMID:Spectrum of complications related to secondary hyperparathyroidism in a peritoneal dialysis patient. 1104 12


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