Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders

Abstract

Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions

Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis

“…The classification tree selected a cutoff score of 28 points in TSK score to determine the degree of kinesiophobia, indicating that phenotype ASP-2 shows a certain degree of fear of arm movement or physical activity. Although pain experience might be driven by peripheral nociception in individuals with acute RCRSP [10], kinesiophobia may play an important role in the clinical picture and prognosis of the condition. A TSK baseline score of about 26 points was observed in non-recovered patients with shoulder pain over one year of follow-up [106].…”

“…Individuals with phenotypes CSP-1 and CSP-2 may represent the great majority of patients with chronic RCRSP seeking treatment. The low efficiency of endogenous pain modulation might represent an imbalance between excitatory and inhibitory sensory inputs indicating that central sensitization drives their pain experience [10], which may be the case in some individuals with RCRSP [109]. Surprisingly, the presence of central sensitization was also found in a minority of individuals with acute RCRSP (13.3%, phenotype ASP-3).…”

Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem?

“…Alternatively, some patients who are clearly affected emotionally by intense pain or for whom central sensitization is the dominant pain mechanism require a more cognitive‐based education, where it can be explained that the anatomical state of their shoulder does not reflect the pain they are experiencing, and that it is more an issue with an excitable nervous system (Louw, Diener, Butler, & Puentedura, ) and tissue deconditioning. For US scanning to be used to its full potential in managing shoulder pain, practitioners also need to be thoroughly acquainted with modern pain neurophysiology and its potential effect on performance, and not only the possible peripheral pathologies involved (Struyf et al, ).…”

The Use of Ultrasound Images in Manual Therapy and Additionally in Assessment of Shoulder Impingement Syndrome

“…Focus: The alterations in scapular muscle function are involved in shoulder pain and specific motor control impairments [14] [15]. During arm elevation, the scapula upwardly rotates and posteriorly tilts while maintaining congruency to the thorax due to the regional stabilizing function of the trapezius and serratus anterior muscles [16] [17] [18].…”