Clinically detectable impairments in patients with subacromial pain syndrome: A case-control study

Abstract

Objective: This study aimed to clearly identify systemic problems, functional impairments, psychological status, and quality of life differences between patients with subacromial pain syndrome (SAPS) and asymptomatic controls, to support the development of multidimensional rehabilitation programs. Additionally, the determinants of symptom severity in SAPS patients were investigated. Methods: This case-control study included 80 participants (40 SAPS patients and 40 controls). The assessments included the prevalence of metabolic syndrome, NSAID consumption, pain severity, upper extremity function, elbow function, wrist-hand function, grip strength, psychological status (kinesiophobia, anxiety, depression, and pain catastrophising), and quality of life. Results: Patients with SAPS showed higher pain levels, DASH scores, NSAID consumption, and prevalence of metabolic syndrome compared to the control group (p<0.05). Functional impairments were detected in scapular upward rotation (90° flexion), elbow flexion strength, wrist-hand function, grip strength, and quality of life (p<0.05). Kinesiophobia and pain catastrophising scores were significantly higher in SAPS patients (p<0.05). Finally, activity-related pain (p=0.017), depression (p=0.015), and grip strength (p<0.001) were identified as significant and independent predictors of disability severity (DASH score), explaining 45.3% of its variance. Conclusion: Clinical impairments in SAPS patients are multidimensional, highlighting the potential benefit of biopsychosocial and multidisciplinary rehabilitation approaches.

Keywords

• Pain
• shoulder
• biopsychosocial
• subacromial pain syndrome

Subakromial ağrı sendromu olan hastalarda klinik olarak saptanabilen bozukluklar: Bir vaka-kontrol çalışması

Abstract

Amaç: Bu çalışmanın amacı, çok boyutlu rehabilitasyon programlarının geliştirilmesini desteklemek için subakromiyal ağrı sendromlu (SAPS) hastalar ile asemptomatik kontroller arasındaki sistemik sorunları, fonksiyonel bozuklukları, psikolojik durumu ve yaşam kalitesi farklılıklarını net bir şekilde tanımlamaktır. Ayrıca, SAPS hastalarında semptom şiddetinin belirleyicileri araştırılmıştır. Yöntemler: Bu vaka-kontrol çalışmasına 80 katılımcı (40 SAPS hastası ve 40 kontrol) dahil edilmiştir. Değerlendirmeler metabolik sendrom prevalansı, NSAID tüketimi, ağrı şiddeti, üst ekstremite fonksiyonu, dirsek fonksiyonu, bilek-el fonksiyonu, kavrama gücü, psikolojik durum (kinezyofobi, anksiyete, depresyon ve ağrı katastrofisi) ve yaşam kalitesini içermektedir. Bulgular: SAPS' lı hastalarda kontrol grubuna kıyasla daha yüksek ağrı seviyeleri, DASH skorları, NSAID tüketimi ve metabolik sendrom prevalansı bulundu (p<0,05). Skapular yukarı rotasyon (90° fleksiyon), dirsek fleksiyon kas kuvveti, el bileği-el fonksiyonu, kavrama gücü ve yaşam kalitesinde fonksiyonel bozukluklar tespit edildi (p<0,05). SAPS hastalarında kinezyofobi ve ağrı katastrofizasyonu skorları anlamlı derecede yüksekti (p<0,05). Son olarak, aktivite ile ilişkili ağrı (p=0,017), depresyon (p=0,015) ve kavrama gücü (p<0,001), engellilik şiddetinin (DASH skoru) anlamlı ve bağımsız belirleyicileri olarak tespit edilmiş ve varyansın %45,3'ünü açıklamıştır. Sonuç: SAPS hastalarındaki klinik bozukluklar çok boyutludur ve biyopsikososyal ve multidisipliner rehabilitasyon yaklaşımlarının potansiyel faydasını vurgulamaktadır.

Keywords

• Ağrı
• omuz
• biyopsikososyal
• subakromial ağrı sendromu.

References

1. 1.Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalenceand incidence of shoulder pain in the generalpopulation; a systematic review. Scand J Rheumatol.2004;33:73-81.
2. 2.Diercks R, Bron C, Dorrestijn O, et al. Guideline fordiagnosis and treatment of subacromial painsyndrome: a multidisciplinary review by the DutchOrthopaedic Association. Acta Orthop. 2014;85:314-22.
3. 3.Karartı C, Basat H, Özsoy İ, et al. BiopsychosocialApproach in Identifying Risk Factors ofKinesiophobia in Persons with Subacromial PainSyndrome and Developing a Clinical Prediction Tool. Indian J Orthop. 2023;57:124-36.
4. 4.Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH.Impingement syndrome of the shoulder. DeutschesÄrzteblatt International. 2017;114:765.
5. 5.Houry M, Bonnard M, Tourny C, Gilliaux M.Kinematic, electromyographic and isokineticmeasurements for the management of shouldersubacromial pain syndrome: A systematic review.Clin Biomech (Bristol, Avon). 2023;107:106029.
6. 6.Overbeek CL, Gademan MG, Kolk A, et al. Reducedpsychosocial functioning in subacromial painsyndrome is associated with persistence ofcomplaints after 4 years. Journal of Shoulder andElbow Surgery. 2021;30:223-8.
7. 7.Martinez-Calderon J, Struyf F, Meeus M, Luque-Suarez A. The association between pain beliefs andpain intensity and/or disability in people withshoulder pain: A systematic review. MusculoskeletSci Pract. 2018;37:29-57.
8. 8.Miranda H, Viikari-Juntura E, Heistaro S,Heliövaara M, Riihimäki H. A population study ondifferences in the determinants of a specificshoulder disorder versus nonspecific shoulder painwithout clinical findings. Am J Epidemiol.2005;161:847-55.

9. 9.Ettinger LR, Shapiro M, Karduna A. SubacromialAnesthetics Increase Proprioceptive Deficit in theShoulder and Elbow in Patients With SubacromialImpingement Syndrome. Clin Med Insights ArthritisMusculoskelet Disord. 2017;10:1179544117713196.
10. 10.AlAnazi A, Alghadir AH, Gabr SA. HandgripStrength Exercises Modulate Shoulder Pain,Function, and Strength of Rotator Cuff Muscles ofPatients with Primary Subacromial ImpingementSyndrome. Biomed Res Int. 2022;2022:9151831.
11. 11.Overbeek CL, Gademan MGJ, Kolk A, et al.Reduced psychosocial functioning in subacromialpain syndrome is associated with persistence ofcomplaints after 4 years. J Shoulder Elbow Surg.2021;30:223-8.
12. 12.Sancho I, Morrissey D, Willy RW, et al.Recreational runners with Achilles tendinopathyhave clinically detectable impairments: A case-control study. Phys Ther Sport. 2022;55:241-7.
13. 13.Wijma AJ, van Wilgen CP, Meeus M, Nijs J. Clinical biopsychosocial physiotherapy assessment ofpatients with chronic pain: The first step in painneuroscience education. Physiother Theory Pract.2016;32:368-84.
14. 14.İğrek S, Çolak TK. Comparison of theeffectiveness of proprioceptive neuromuscularfacilitation exercises and shoulder mobilizationpatients with Subacromial Impingement Syndrome:A randomized clinical trial. J Bodyw Mov Ther.2022;30:42-52.
15. 15.Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve elsorunları (disabilities of the arm, shoulder andhand-DASH) anketi Türkçe uyarlamasınıngüvenirliği ve geçerliği. Fizyoterapi Rehabilitasyon.2006;17:99-107.
16. 16.Ozturk O, Sari Z, Ozgul B, Tasyikan L. Validity and reliability of the turkish" patient-rated wristevaluation" questionnaire. Acta Orthop TraumatolTurc. 2015;49:120-5.
17. 17.Öksüz Ç, Akel BS, Oskay D, Leblebicioğlu G,Hayran KM. Cross-cultural adaptation, validation,and reliability process of the Michigan HandOutcomes Questionnaire in a Turkish population.The Journal of hand surgery. 2011;36:486-92.
18. 18.Lee SC, Wu LC, Chiang SL, et al. Validating theCapability for Measuring Age-Related Changes inGrip-Force Strength Using a Digital Hand-HeldDynamometer in Healthy Young and Elderly Adults.Biomed Res Int. 2020;2020:6936879.
19. 19.Yilmaz ÖT, Yakut Y, Uygur F, Uluğ N. TampaKinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon.2011;22:44-9.
20. 20.Aydemir Ö, Güvenir T, Küey L, Kultur S. HospitalAnxiety and Depression Scale Turkish form:validation and reliability study. Türk Psikiyatri Der.1997;8:280e7.
21. 21.Ugurlu M, Karakas Ugurlu G, Erten S, Caykoylu A.Validity of Turkish form of Pain CatastrophizingScale and modeling of the relationship between and emotional factors. Psychiatry and Clinical Psychopharmacology. 2017;27:189-96.
22. 22.Soylu C, Kütük B. SF-12 Yaşam Kalitesi Ölçeği’ninTürkçe formunun güvenirlik ve geçerlik çalışması.Türk Psikiyatri Dergisi. 2021;1.
23. 23.Watson LA, Pizzari T, Balster S. Thoracic outletsyndrome part 2: conservative management ofthoracic outlet. Man Ther. 2010;15:305-14.
24. 24.Ozsoy G, Ilcin N, Ozsoy I, et al. The Effects OfMyofascial Release Technique Combined With CoreStabilization Exercise In Elderly With Non-SpecificLow Back Pain: A Randomized Controlled, Single-Blind Study. Clin Interv Aging. 2019;14:1729-40.
25. 25.Dai J, Teng L, Zhao L, Zou H. The combinedanalgesic effect of pregabalin and morphine in thetreatment of pancreatic cancer pain, a retrospectivestudy. Cancer Med. 2021;10:1738-44.
26. 26.Kararti C, Bilgin S, Dadali Y, et al. Does PlantarPressure Distribution Influence the LumbarMultifidus Muscle Thickness in AsymptomaticIndividuals? A Preliminary Study. J ManipulativePhysiol Ther. 2020;43:909-21.
27. 27.Burne G, Mansfield M, Gaida JE, Lewis JS. Is therean association between metabolic syndrome androtator cuff-related shoulder pain? A systematicreview. BMJ Open Sport Exerc Med.2019;5:e000544.
28. 28.Rechardt M, Shiri R, Karppinen J, et al. Lifestyleand metabolic factors in relation to shoulder painand rotator cuff tendinitis: a population-basedstudy. BMC Musculoskelet Disord. 2010;11:165.
29. 29.Ranger TA, Wong AM, Cook JL, Gaida JE. Is therean association between tendinopathy and diabetesmellitus? A systematic review with meta-analysis. Br J Sports Med. 2016;50:982-9.
30. 30.Goodson NJ, Smith BH, Hocking LJ, et al.Cardiovascular risk factors associated with themetabolic syndrome are more prevalent in peoplereporting chronic pain: results from a cross-sectional general population study. Pain.2013;154:1595-602.
31. 31.Kibler WB, Ludewig PM, McClure PW, et al.Clinical implications of scapular dyskinesis inshoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med.2013;47:877-85.
32. 32.Saito H, Harrold ME, Cavalheri V, McKenna L.Scapular focused interventions to improve shoulderpain and function in adults with subacromial pain: Asystematic review and meta-analysis. PhysiotherTheory Pract. 2018;34:653-70.
33. 33.Mostafaee N, Divandari A, Negahban H, et al.Shoulder and scapula muscle training plusconventional physiotherapy versus conventionalphysiotherapy only: a randomized controlled trial ofpatients with lateral elbow tendinopathy.Physiother Theory Pract. 2022;38:1153-64.
34. 34.Alizadehkhaiyat O, Fisher AC, Kemp GJ,Vishwanathan K, Frostick SP. Shoulder muscleactivation and fatigue during a controlled forcefulhand grip task. J Electromyogr Kinesiol.2011;21:478-82.
35. 35.Mandalidis D, O'Brien M. Relationship betweenhand-grip isometric strength and isokinetic momentdata of the shoulder stabilisers. J Bodyw Mov Ther.2010;14:19-26.