Heterogeneity among patients with subacromial pain – variabilities within clinical presentation and its impact on daily life. (September 2021)

• Record Type: Journal Article
• Authors: Nordqvist, Jenny M.; Öberg, Birgitta E.; Adolfsson, Lars E.; Holmgren, Theresa M.; Johansson, Kajsa M.
• Is Part Of: Physiotherapy. Volume 112(2021)
• Page Start: 113
• Page End: 120
• Publication Date: 2021-09
• Subjects: Shoulder Impingement Syndrome -- Clinical Presentation -- Range of Motion Articular -- Rotator Cuff -- Scapular Dyskinesia -- Primary Health Care; Physical therapy -- Periodicals; Therapeutics, Physiological -- Periodicals; 615.8205
• DOI: 10.1016/j.physio.2020.10.001
• Languages: English
• ISSNs: 0031-9406

Abstract

Highlights: Highlights the heterogeneity among patients with subacromial pain in primary care by describing a variability of the three components; active range of motion, rotator cuff function and scapular kinematics. All three components maybe found in isolation or in combination with each other. Describes that rotator cuff dysfunction, defined as pain during resisted isometric muscle-testing, is very frequent while limitation in active range of motion and scapular dyskinesia are more inconsistent. Demonstrates the significant but rather weak associations between the components in clinical presentation and their respective impact on daily life. Abstract: Objective: The primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life. Design and setting: A cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life. Participants: Patients aged 30-67 years, describing pain for more than two weeks, with positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe's test, and painful arc. Results: Among the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients. Conclusions: These results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.