Reliability of the Shoulder Symptom Modification Procedure and association of within-session and between-session changes with functional outcomes

Meakins, Adam; May, Stephen; Littlewood, Chris

doi:10.1136/bmjsem-2018-000342

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…The primary outcome (QuickDASH) and most other secondary outcomes of interest showed no between‐group differences over time. This is consistent with other studies showing that within‐session changes do not necessarily equate to longer‐term improvements in shoulder pathology (Meakins et al., 2018). This finding contrasts with the short‐term predictive capacity of immediate effects in the literature.…”

Section: Discussionsupporting

confidence: 92%

“…Previous work has addressed SAPS and found that a large within‐session effect for perceived improvement as determined by a ≥5 GRoC did not correlate to functional change scores (J. C. Garrison et al., 2011). A second study found a poor correlation between within‐session pain score changes and 1‐ or 3‐month pain outcomes (Meakins et al., 2018). A strong correlation from within‐session change scores to 1‐week, moderate to 1‐month, and fair to 3‐month functional outcomes (Meakins et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

“…A second study found a poor correlation between within‐session pain score changes and 1‐ or 3‐month pain outcomes (Meakins et al., 2018). A strong correlation from within‐session change scores to 1‐week, moderate to 1‐month, and fair to 3‐month functional outcomes (Meakins et al., 2018). What neither of these studies pragmatically capture is the patient's change in primary symptomatic response at the initial evaluation subjectively and objectively and determine how these variables may predict their immediate and short‐term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

Riley

Harris

O’Halloran³

et al. 2021

Physiotherapy Res Intl

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Objectives The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2‐week, 4‐week, and 6‐month follow‐up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery. Methods This was a prospective, single‐group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2‐week, 4‐week, and 6‐month follow‐up. Results The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between‐group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between‐group difference exceeded the minimal detectable change at 4 weeks. The pair‐wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4‐week follow‐up (rpb (112) = 0.27, p = 0.004). Conclusion Individuals with SAPS may benefit from shoulder mobilization independent of their within‐session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within‐session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

Riley

Harris

O’Halloran³

et al. 2021

Physiotherapy Res Intl

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“…Yet, the authors acknowledged that the efficacy of the Shoulder Symptom Modification Procedure (SSMP) in treating shoulder pain was yet to be established. The other more recent study [ 175 ] reported moderate inter-rater reliability but found the association between within-session and between-session changes in pain regarding treatment efficacy for the Shoulder Symptom Modification Procedure (SSMP) to be insufficient. The authors consequently concluded that the Shoulder Symptom Modification Procedure (SSMP) was not reliable or valid for managing shoulder pain.…”

Section: Assessmentmentioning

confidence: 99%

The long head of biceps at the shoulder: a scoping review

Diplock

Hing

Marks

2023

BMC Musculoskelet Disord

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Background This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. Methods PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. Results 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep’s role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy’s limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. Conclusions The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. Pre-registration OSF: https://osf.io/erh9m

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“…scapular dyskinesis test) and ( 4) lower extremity physical performance tests (e.g., single leg balance). Some controversy exists regarding the use of symptom modification tests 39 and scapular dyskinesis tests 67 . Additionally, the star excursion balance test, which did not meet consensus, appears to be the only lower extremity physical performance test correlated with shoulder injury risk.…”

Section: Physical Examinationmentioning

confidence: 99%

Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain

Lluch-Girbés¹,

Requejo-Salinas²,

Fernández-Matías³

et al. 2023

Journal of Shoulder and Elbow Surgery

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Reliability of the Shoulder Symptom Modification Procedure and association of within-session and between-session changes with functional outcomes

Cited by 7 publications

References 18 publications

Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

The long head of biceps at the shoulder: a scoping review

Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain

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