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Old 01-24-2008, 06:50 PM   #46
Dan Hollingsworth
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Join Date: Oct 2007
Location: Poulsbo  WA
Posts: 129
Re: Avoiding shoulder injuries, and fixing them - What's the best course of action?

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]
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