DATA FROM CLINICAL AND INSTRUMENTAL EXAMINATIONS OF PATIENTS WITH CHRONIC PAIN IN THE SHOULDER JOINT

Chronic shoulder pain (CSP) is one of the most common reasons for seeking medical care. Identifying the specific cause of CSP is necessary to determine the treatment strategy.

Objective: to determine which pathology of the musculoskeletal system is the main cause of CSP.

Subjects and methods. A study group consisted of 151 patients (49.7% females; mean age, 49.8±18.8 years), who experienced shoulder joint pain that persisted when taking nonsteroidal anti-inflammatory drugs (NSAIDs) and after local administration of glucocorticoids. They underwent clinical and instrumental studies (radiography, magnetic resonance imaging, and ultrasound). The investigators assessed pain intensity using a visual analogue scale (VAS), and functional impairment with the American Shoulder and Elbow Surgeons (ASES) Assessment Scores and the Constant Score (CS).

Results and discussion. The mean CSP intensity at rest and during movement was 56.1±21.7 and 67.3±19.1 mm VAS. The degree of functional disorders was 55.5±17.6 ASES scores and 54.1±14.5 CS scores. Tendonitis that is an injury to the tendon of the supraspinatus muscle (74.8%) was most common. There was shoulder osteoarthritis (OA) in 31.7%, acromioclavicular (AC) OA in 19.2%, rotator cuff tendon injury concurrent with shoulder OA in 25.2%, that with AC OA in 16.6%, and that with shoulder OA and AC OA in 9.2%. The intensity of pain with only rotator cuff tendon injury and that  concurrent with shoulder OA and/or AC OA did not differ and that averaged 57.2±20.2 and 54.6±18.6 mm at rest, respectively, and 68.3±22.4 and 65.4±19.2 mm during movement (p>0.05 in both cases).

Conclusion. The main cause of CSP is tendonitis of the rotator cuff, primarily of the supraspinatus muscle. Moreover, more than half of patients have rotator cuff tendon injury concurrent with biceps tendon injury, shoulder OA and/or AC OA. 

1. Chang RF, Lee CC, Lo CM. Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition. PLoS One. 2019 Feb 28;14(2):e0212741. doi: 10.1371/journal.pone.0212741.eCollection 2019.

2. Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016 Jun;23:57-68. doi: 10.1016/j.math.2016.03.009. Epub 2016 Mar 26.

3. Dougados M, Le Henanff A, Logeart I, Ravaud P. Short-term efficacy of rofecoxib and diclofenac in acute shoulder pain: a placebocontrolled randomized trial. PLoS Clin Trials. 2007 Mar 9;2(3):e9. doi: 10.1371/journal.pctr.0020009

4. Fanavoll R, Nilsen TI, Holtermann A, Mork PJ. Psychosocial work stress, leisure time physical exercise and the risk of chronic pain in the neck/shoulders: Longitudinal data from the Norwegian HUNT Study. Int J Occup Med Environ Health. 2016;29(4):585-95. doi: 10.13075/ijomeh.1896.00606

5. Takura T, Ushida T, Kanchiku T, et al. The societal burden of chronic pain in Japan: an internet survey. J Orthop Sci. 2015 Jul;20(4):750-60. doi: 10.1007/s00776-015-0730-8. Epub 2015 May 12.

6. Van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995 Dec;54(12):959-64. doi: 10.1136/ard.54.12.959

7. Djade CD, Porgo TV, Zomahoun HT, et al. Incidence of shoulder pain in 40 years old and over and associated factors: A systematic review. Eur J Pain. 2020 Jan;24(1):39-50. doi: 10.1002/ejp.1482. Epub 2019 Oct 13.

8. Andersen LL, Clausen T, Persson R, Holtermann A. Perceived physical exertion during healthcare work and prognosis for recovery from long-term pain in different body regions: Prospective cohort study. BMC Musculoskelet Disord. 2012 Dec 19;13:253. doi: 10.1186/1471-2474-13-253

9. Frisch KE, Clark J, Hanson C, et al. High prevalence of nontraumatic shoulder pain in a regional sample of female high school volleyball athletes. Orthop J Sports Med. 2017 Jun 23;5(6):2325967117712236. doi: 10.1177/2325967117712236. eCollection 2017 Jun.

10. Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy. 2015 Jun;101(2):147-54. doi: 10.1016/j.physio.2014.07.003. Epub 2014 Sep 19.

11. Juel NG, Brox JI, Brunborg C, et al. Very high prevalence of frozen shoulder in patients with type 1 diabetes of ≥45 years' duration: The Dialong Shoulder Study. Arch Phys Med Rehabil. 2017 Aug;98(8):1551-9. doi: 10.1016/j.apmr.2017.01.020. Epub 2017 Feb 17.

12. Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthop Res Rev. 2018 Oct 23;10:83-91. doi: 10.2147/ORR.S157864. eCollection 2018.

13. Ansok CB, Muh SJ. Optimal management of glenohumeral osteoarthritis. Orthop Res Rev. 2018 Feb 23;10:9-18. doi: 10.2147/ORR.S134732. eCollection 2018.

14. Imametdinova GR, Chichasova NV, Nasonov EL, Arkhipov SV. Metody klinicheskogo issledovaniya oporno-dvigatel'nogo apparata v revmatologii i revmoortopedii [Methods of a clinical study of the musculoskeletal system in rheumatology and rheumatology]. Moscow: IMA-PRESS; 2011. 160 p. (In Russ.)

15. Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 2008 May;90(5):970-9. doi: 10.2106/JBJS.F.01116

16. Kobayashi T, Takagishi K, Shitara H, et al. Prevalence of and risk factors for shoulder osteoarthritis in Japanese middle-aged and elderly populations. J Shoulder Elbow Surg. 2014 May;23(5):613-9. doi: 10.1016/j.jse.2013.11.031. Epub 2014 Feb 20.

17. Oh JH, Chung SW, Oh CH, et al. The prevalence of shoulder osteoarthritis in the elderly Korean population: association with risk factors and function. J Shoulder Elbow Surg. 2011 Jul;20(5):756-63. doi: 10.1016/j.jse.2011.01.021. Epub 2011 May 6.

18. Menge TJ, Boykin RE, Bushnell BD, Byram IR. Acromioclavicular osteoarthritis: a common cause of shoulder pain. South Med J. 2014 May;107(5):324-9. doi: 10.1097/SMJ.0000000000000101

19. Buttaci CJ, Stitik TP, Yonclas PP, Foye PM. Osteoarthritis of the acromioclavicular joint: a review of anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil. 2004 Oct;83(10):791-7. doi: 10.1097/01.PHM.0000140804.46346.93

20. Needell SD, Zlatkin MB, Sher JS, et al. MR imaging of the rotator cuff: peritendinous and bone abnormalities in an asymptomatic population. AJR Am J Roentgenol. 1996 Apr;166(4):863-7. doi: 10.2214/ajr.166.4.8610564

21. Frigg A, Song D, Willi J, et al. Seven-year course of asymptomatic acromioclavicular osteoarthritis diagnosed by MRI. J Shoulder Elbow Surg. 2019 Oct;28(10):e344-e351. doi: 10.1016/j.jse.2019.04.004. Epub 2019 Jul 3.

22. Redondo-Alonso L, Chamorro-Moriana G, JimОnez-Rejano JJ, et al. Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: systematic review. BMC Musculoskelet Disord. 2014 Nov 18;15:377. doi: 10.1186/1471-2474-15-377

23. Laslett LL, Otahal P, Hensor EM, et al. Knee pain predicts subsequent shoulder pain and the association is mediated by leg weakness: Longitudinal observational data from the osteoarthritis initiative. J Rheumatol. 2016 Nov;43(11):2049-55. doi: 10.3899/jrheum.160001. Epub 2016 Oct 1.

24. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec;23(12):1913-21. doi: 10.1016/j.jse.2014.08.001