Semptomatik Rotator Kaf Yırtığı olan Hastalarda Santral Sensitizasyonun Omuz Ağrı ve Disabilite Üzerine Etkisi

Year 2023, Volume: 5 Issue: 2, 110 - 116, 28.06.2023

İsa Cüce , Rıdvan Yıldızhan , Enes Veziroğlu , Hasan Kara , Şuayb Celalettin Sayın , Mustafa Çalış

https://doi.org/10.52827/hititmedj.1285524

Abstract

Amaç: Rotator kaf (RK) yırtığı olan hastalarda santral sensitizasyon (SS) varlığı şimdiye kadar araştırılmamıştır. Bu çalışmada, semptomatik RK yırtığı olan hastalarda SS varlığının omuz ağrısı ve disabilite üzerine etkisini araştırmak amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya, kronik RK yırtığı olan 52 semptomatik hasta ve hastalar ile yaş/cinsiyet olarak eşleştirilmiş 35 sağlıklı kontrol dâhil edildi. SS varlığı ve şiddeti Santral Sensitizasyon Ölçeği (SSÖ) ile değerlendirildi. Ağrı duyarlılığı için lokal (etkilenen omuz) ve uzak (tibialis anterior) bölgelerden basınç-ağrı eşikleri (BAE) kaydedildi. Hasta grubunda ağrı ve disabilite, Vizüel Analog Skala (ağrı) ve Omuz Ağrı ve Disabilite İndeksi (OADİ) ile değerlendirildi.
Bulgular: Hasta grubunun kontrol grubuna göre SSÖ skorları anlamlı yüksek (p < 0,001) ve deltoidden ölçülen BAE değerleri anlamlı düşüktü (p = 0,040). SS (SSÖ skoru ≥ 40), hastaların 24 (%46,2)’ünde saptandı. SS’si olan hasta grubunda olmayanlara göre OADİ-ağrı skorları anlamlı yüksekti (p = 0,034). SSÖ skorları ile OADİ-ağrı skorları (r = 0,299) ve üst trapez (r = -0,302) ve deltoidden (r = -0,325) ölçülen BAE değerleri arasında orta derecede korelasyonlar saptandı (p < 0,05).
Sonuç: Bu çalışma, RK yırtığı olan hastaların yaklaşık yarısında SS olduğunu gösterdi. Buna karşın, lokal bölgeden (deltoid) ölçülen BAE değerinin sağlıklı kontrol grubundan anlamlı düşük bulunması sadece periferik sensitizasyon ile ilişkilendirilebilir. Ayrıca, RK yırtığına bağlı gelişen SS hastalarda disabiliteden ziyade artan ağrı yükü ile ilişkili gözükmektedir.

Keywords

Kronik omuz ağrısı, rotator kaf yırtığı, santral sensitizasyon, ağrı duyarlılığı, disabilite

Supporting Institution

Yoktur

Project Number

Uygun Değil

Thanks

Yoktur

The Effect of Central Sensitization on Shoulder Pain and Disability in Patients with Symptomatic Rotator Cuff Tear

Abstract

Objective: The presence of central sensitization (CS) in patients with rotator cuff tears has not been investigated thus far. This study aimed to investigate the effects of CS on shoulder pain and disability in patients with symptomatic rotator cuff (RC) tears.
Material and Method: The study included 52 symptomatic patients diagnosed with chronic RC tears and 35 age- and sex-matched healthy controls. CS was evaluated with the Central Sensitization Inventory (CSI). Pressure-pain thresholds (PPTs) were recorded at both local (affected shoulder) and remote (tibialis anterior) sites. Pain and disability were measured using the Visual Analogue Scale for pain, and the Shoulder Pain and Disability Index in the patient group.
Results: The patient group had significantly higher CSI scores (p < 0.001) and significantly lower deltoid PPT levels than the control group (p = 0.040). CS (CSI score ≥ 40) was detected in 24 (46.2%) of the patients. The SPADI-pain scores were significantly higher in patients with CS compared to those without (p = 0.034). The CSI scores moderately correlated with SPADI-pain scores (r = 0.299), and the upper trapezius (r = -0.302) and deltoid (r = -0.325) PPT levels (p < 0,05).
Conclusion: This study showed that approximately half of the patients with RC tear had CS. However, the significantly lower PPT levels at the local site (deltoid) compared to the control group may only be associated with peripheral sensitization. In addition, CS due to RC tear seems to be associated with increased pain rather than disability.

Keywords

Chronic shoulder pain, rotator cuff tear, central sensitization, pain sensitivity, disability

Project Number

Uygun Değil

References

• Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010;19(1):116-120.
• Reilly P, Macleod I, Macfarlane R, Windley J, Emery R. Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 2006;88(2):116-121.
• Mall NA, Lee AS, Chahal J, et al. An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy 2013;29(2):366-376.
• Longo UG, Risi Ambrogioni L, Candela V, et al. Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis. BMC Musculoskelet Disord 2021;22(1):50.
• Hinsley H, Ganderton C, Arden NK, Carr AJ. Prevalence of rotator cuff tendon tears and symptoms in a Chingford general population cohort, and the resultant impact on UK health services: a cross-sectional observational study. BMJ Open 2022;12(9):e059175.
• Bachasson D, Bachasson D, Singh A, Shah SB, Lane JG, Ward SR. The role of the peripheral and central nervous systems in rotator cuff disease. J shoulder Elbow Surg 2015;24(8):1322-1335.
• Lemaster NG, Hettrich CM, Jacobs CA, et al. Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear? Clin Orthop Relat Res 2021;479(9):1982-1992.
• Nijs J, George SZ, Clauw DJ, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol 2021;3(5):e383-e392.
• Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: a systematic literature review. Semin Arthritis Rheum 2015;44(6):710-716.
• Walankar PP, Panhale VP, Patil MM. Psychosocial factors, disability and quality of life in chronic shoulder pain patients with central sensitization. Health Psychol Res 2020;8(2):8874.
• Bilika P, Nijs J, Fandridis E, Dimitriadis Z, Strimpakos N, Kapreli E. In the Shoulder or in the Brain? Behavioral, Psychosocial and Cognitive Characteristics of Unilateral Chronic Shoulder Pain with Symptoms of Central Sensitization. Healthcare (Basel) 2022;10(9):1658.
• Balasch-Bernat M, Dueñas L, Aguilar-Rodríguez M, et al. The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder. J Clin Med 2021;11(1):154.
• Bumin G, Tüzün EH, Tonga E. The Shoulder Pain and Disability Index (SPADI): Cross-cultural adaptation, reliability, and validity of the Turkish version. J Back Musculoskelet Rehabil 2008;21(1):57-62.
• Keleş ED, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. Arc Rheumatol 2021;36(4):518-526.
• Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013;14(5):438-445.
• Bisset LM, Evans K, Tuttle N. Reliability of 2 protocols for assessing pressure pain threshold in healthy young adults. J Manipulative Physiol Ther 2015;38(4):282-287.
• Yadav S. Correlation analysis in biological studies. J Pract Cardiovascular Sci 2018;4(2):116-121.
• Senthilkumar SN, Dhanani DP, Vashi RH, Barot DN, Savani MN. Recognition of central nervous system sensitization and its risk factors in patients with unilateral musculoskeletal shoulder pain. Physiotherapy 2019;13(2):102.
• Struyf F, Lluch E, Falla D, Meeus M, Noten S, Nijs J. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders. Eur J Appl Physiol 2015;115(2):225-234.
• Coronado RA, Simon CB, Valencia C, George SZ. Experimental pain responses support peripheral and central sensitization in patients with unilateral shoulder pain. Clin J Pain 2014;30(2):143-51.
• Yan CQ, Zhang S, Li QQ, et al. Detection of peripheral and central sensitisation at acupoints in patients with unilateral shoulder pain in Beijing: a cross-sectional matched case-control study. BMJ Open 2017;7(6):e014438.
• Alburquerque-Sendín F, Camargo PR, Vieira A, Salvini TF. Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome: a blinded, controlled study. Clin J Pain 2013;29(6):478-486.
• Noten S, Struyf F, Lluch E, D’Hoore M, Van Looveren E, Meeus M. Central Pain Processing in Patients with Shoulder Pain: A Review of the Literature. Pain Pract 2017;17(2):267-280.
• Coronado RA, George SZ. The Central Sensitization Inventory and Pain Sensitivity Questionnaire: An exploration of construct validity and associations with widespread pain sensitivity among individuals with shoulder pain. Musculoskelet Sci Pract 2018;36:61-67.
• Matesanz-García L, Cuenca-Martínez F, Simón AI, et al. Signs Indicative of Central Sensitization Are Present but Not Associated with the Central Sensitization Inventory in Patients with Focal Nerve Injury. J Clin Med 2022;11(4):1075.
• Gervais-Hupé J, Pollice J, Sadi J, Carlesso LC. Validity of the central sensitization inventory with measures of sensitization in people with knee osteoarthritis. Clin Rheumatol 2018;37(11):3125-3132.
• Kregel J, Schumacher C, Dolphens M, et al. Convergent Validity of the Dutch Central Sensitization Inventory: Associations with Psychophysical Pain Measures, Quality of Life, Disability, and Pain Cognitions in Patients with Chronic Spinal Pain. Pain Pract 2018;18(6):777-787.
• Razmjou H, Davis AM, Jaglal SB, Holtby R, Richards RR. Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord 2011;12:66.
• King J, Shapiro M, Karduna A. Peripheral sensitization is demonstrated in subacromial pain syndrome, with central sensitization found only in females. J Orthop Res 2023;41(2):255-62.
• Rashid MS, Cooper C, Cook J, et al. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year. Acta Orthop 2017;88(6):606-611.