Avoiding shoulder injuries, and fixing them - What's the best course of action?

[Lenora Galitz-Pfeffer]

Originally Posted by Joe Waguespack

I am wondering about that because a few years ago i was dealing with horrible tendonitis in my elbows and biceps I tried cortisone injections, when that didn't work my doctor sent me to a PT who ran me through a bunch of different things ( massage of the area, exercises, ect.) and that only seemed to make the pain worse. After I finally gave up and figured it was just a pain I would have to deal with if I wanted to continue training my Chiro. suggested using the muscle stim. and ultra sound on my problems and within two weeks the pain was gone and never returned. I am just wondering why these would be considered ineffective modalities? They were very effective on me when nothing else worked.

My chiro used electro stim and ultra sound on my back, and my pt used them on my back and shoulders. It may be a matter of selecting that treatment after assessing what's needed. The body is very complex, so, sometimes we have to make a few visits with different practitioners. Cortisone has also made my rc worse, and so did massage. That was from an orthopedic physician, and massage(by my chiro). Sometimes the practitioners have to try a few things in their little black bag. I'm glad you found relief within two weeks with muscle stim and ultra sound. They make a big difference.

[Dan Hollingsworth]

There are plenty of anecdotal reports of ultrasound, e-stim and the plethora of other modalities that are utilized by physical therapists, occupational therapists and now chiropractors are helpful. However, when these modalities are truly put to the test in double-blind, randomized, controlled clinical studies, they just don't cut it. Plain and simple. Several studies have been done and essentially all of the well done studies have come up with the same conclusion, these are not efficacious modalities. They have also been meta-analyses (the gold standard of clinical research) that have come up with the same conclusions.

Now, am I saying that after your ultrasound or e-stim treatment that you did not feel better? No, like I said plenty of people report that it "helps" them. The placebo effect is a real effect. As a physical therapist if a patient comes to me and says "I had this problem a few years ago and the only thing that helped was ultrasound." Well, guess what, they're likely going to get ultrasound, in addition to a lot of education and therapeutic exercises to hopefully provide them long-term benefit.

If you would like references to the studies I can get them for you.

[Dan Hollingsworth]

[QUOTE=Steven Low;247069]



Internet "diagnosing" is quite fun for me actually and I'm fairly decent at it


QUOTE]

Steven,

Please know that I am not trying to pick a fight with you or bash you on this forum. I'm still new to the forum, so i certainly don't want to **** anyone off, not yet at least

At any rate, what may be "fun" for you could be potentially harmful for the person on the receiving end. I read your posts on this thread, and in all likelihood you are on the spot with your assessment, but the simple truth is that you don't have enough information to make a truly informed assessment. I think it is always important to make certain to post on these types of threads the important caveat that assessment, IN PERSON, by a physician, therapist, chiropractor, or some other trained professional is always the best first choice.

[Theresa Meyer]

I had x-rays and an MRI on Tuesday and will follow up with orthopedics in another week. In the meantime, I've already started working on strengthening my rhomboids with resistance bands and by squeezing my shoulder blades together while working at my desk.

[Tom Rawls]

Dan--

I'd be interested in a reference or two.

You've got me wondering why I'm paying for treatments. I feel better, but that may be because, first, I stopped doing the things that cause pain (its amazing how stupid and stubborn I--we--can be in avoiding this simple step), and second, started rehab exercises.

[Dan Hollingsworth]

Tom,

Here's a few to start with. I know there is a meta-analysis out there somewhere, just can't find. I'm running back and forth between cooking dinner, searching for articles and getting mentally prepared for my CF workout tonight. PM me if you need more info.

Dan

prospective double blind placebo-controlled randomized trial of ultrasound in the physiotherapy treatment of shoulder pain.
Ainsworth R, Dziedzic K, Hiller L, Daniels J, Bruton A, Broadfield J.
Rheumatology (Oxford) 2007; 46(5): 815-820
School of Health Sciences, University of Birmingham, UK. roberta.ainsworth@nhs.net

OBJECTIVE: To compare the effectiveness of manual therapy and ultrasound (US) with manual therapy and placebo ultrasound (placebo US) in the treatment of new episodes of unilateral shoulder pain referred for physiotherapy. METHODS: In a multicentre, double blind, placebo-controlled randomized trial, participants were recruited with a clinical diagnosis of unilateral shoulder pain from nine primary care physiotherapy departments in Birmingham, UK. Recruitment took place from January 1999 to September 2001. Participants were 18 yrs old and above. Participants all received advice and home exercises and were randomized to additionally receive manual therapy plus US or manual therapy plus placebo US. The primary outcome measure was the Shoulder Disability Questionnaire (SDQ-UK). Outcomes were assessed at baseline, 2 weeks, 6 weeks and 6 months. Analysis was by intention to treat. RESULTS: A total of 221 participants (mean age 56 yrs) were recruited. 113 participants were randomized to US and 108 to placebo US. There was 76% follow up at 6 weeks and 71% at 6 months. The mean (95% CI) reduction in SDQ scores at 6 weeks was 17 points (13-26) for US and 13 points (9-17) for placebo US (P = 0.06). There were no statistically significant differences at the 5% level in mean changes between groups at any of the time points. CONCLUSIONS: The addition of US was not superior to placebo US when used as part of a package of physiotherapy in the short-term management of shoulder pain. This has important implications for physiotherapy practice.

PMID: 17218327 [PubMed - indexed for MEDLINE]


Pulsed ultrasound treatment of the painful shoulder a randomized, double-blind, placebo-controlled study.
Nykänen M.
Scand J Rehabil Med 1995; 27(2): 105-108
Punkaharju Rehabilitation Hospital, Finland.

To study the effect of pulsed ultrasound in shoulder pains, 35 patients were treated with pulsed ultrasound and 37 patients with placebo ultrasound in a double-blind design. The therapy was given during inpatient rehabilitation, 10-12 treatments over 3-4 weeks. Treatment time was 10 minutes, frequency 1.0mHz, on-off ratio 1:4 and intensity 1.0w/cm2. Follow-ups were done after 4-12 months. No differences (p < 0.05) in outcomes were found between the groups after the treatment period or at follow-ups. These results discourage the adding of pulsed ultrasound therapy with the variables used to the conservative treatment of the painful shoulder.

PMID: 7569819 [PubMed - indexed for MEDLINE]



No effect of bipolar interferential electrotherapy and pulsed ultrasound for soft tissue shoulder disorders: a randomised controlled trial.
Van Der Heijden GJ, Leffers P, Wolters PJ, Verheijden JJ, van Mameren H, Houben JP, Bouter LM, Knipschild PG.
Ann Rheum Dis 1999; 58(9): 530-540
Institute for Rehabilitation Research, Hoensbroek, The Netherlands.

OBJECTIVE: To assess the efficacy of bipolar interferential electrotherapy (ET) and pulsed ultrasound (US) as adjuvants to exercise therapy for soft tissue shoulder disorders (SD). METHODS: Randomised placebo controlled trial with a two by two factorial design plus an additional control group in 17 primary care physiotherapy practices in the south of the Netherlands. Patients with shoulder pain and/or restricted shoulder mobility, because of a soft tissue impairment without underlying specific or generalised condition, were enrolled if they had not recovered after six sessions of exercise therapy in two weeks. They were randomised to receive (1) active ET plus active US; (2) active ET plus dummy US; (3) dummy ET plus active US; (4) dummy ET plus dummy US; or (5) no adjuvants. Additionally, they received a maximum of 12 sessions of exercise therapy in six weeks. Measurements at baseline, 6 weeks and 3, 6, 9, and 12 months later were blinded for treatment. Outcome measures: recovery, functional status, chief complaint, pain, clinical status, and range of motion. RESULTS: After written informed consent 180 patients were randomised: both the active treatments were given to 73 patients, both the dummy treatments to 72 patients, and 35 patients received no adjuvants. Prognosis of groups appeared similar at baseline. Blinding was successfully maintained. At six weeks seven patients (20%) without adjuvants reported very large improvement (including complete recovery), 17 (23%) and 16 (22%) with active and dummy ET, and 19 (26%) and 14 (19%) with active and dummy US. These proportions increased to about 40% at three months, but remained virtually stable thereafter. Up to 12 months follow up the 95% CI for differences between groups for all outcomes include zero. CONCLUSION: Neither ET nor US prove to be effective as adjuvants to exercise therapy for soft tissue SD.

PMID: 10460185 [PubMed - indexed for MEDLINE]

[Steven Low]

If it makes ya happy I'll add a disclaimer.

[Tom Rawls]

Thanks, Dan. Generous of you to track those citations.

[Lenora Galitz-Pfeffer]

Originally Posted by Theresa Meyer

I had x-rays and an MRI on Tuesday and will follow up with orthopedics in another week. In the meantime, I've already started working on strengthening my rhomboids with resistance bands and by squeezing my shoulder blades together while working at my desk.

Glad you are strengthening your rhomboids. Good idea to have the x rays and MRI. You'll get some good info there. Good luck.

[Lenora Galitz-Pfeffer]

Dan, that's for posting the studies, and welcome to the forum.