Shoulder pain mapping for common shoulder disorders

Background:Pain mapping for specific disorders was described in the literature for face, back and hip pain, but not for shoulder pain.The aim of the study was to fill the gap in assessing patients as a whole for common shoulder disorders, to develop a pathway from subjective experience of patients to diagnoses of pathology, to ascertain specific patterns of pain in patients with common shoulder disorders, to describe comprehensive shoulder pain maps and to test these.Method: The study was designed in three phases with prospective blinded method. The first phase aimed to establish the pain patterns for common shoulder disorders. The patients, who presented as new patients with shoulder pain to the outpatient department, were given a custom-made shoulder mapping form to mark their pain, its character and severity. The patients’ final diagnoses were coded after investigations and the codes were correlated with the pain map patterns to achieve the aim. Later, colour-coded maps were established for each shoulder disorder. SPSS (statistic package) was used for the first study.The second phase was designed to test the accuracy of the previously established colourcoded pain patterns in the first phase, to assess sensitivity and specificity of the maps for Levent Bayam @00279526the disease groups and each individual disorder, to improve the previous pain mappings and to establish an algorithm. This was achieved by collecting the maps from a larger number of the patients than the first phase’s number and the researcher, who was blind to the diagnoses, gave his estimations for each map immediately after collecting the maps from each patient. After all the investigations, treatments and follow-ups, the final diagnoses were coded. The final phase was to assess inter-tester reliability. The third phase was to test inter-tester reliability of the maps by estimating the shoulder diagnoses using algorithm and colourcoded maps by three raters. This test was used to observe a score of how much consensus or homogeneity there was for the algorithm of the shoulder pain maps. Another aim in thethird phase was to examine if the mapping system is easy to use or requires a lot of training. Statsdirect and VassarStats were used to analyse statistical data in the second and the third phases of the study. Ethical opinion was sought from the local R&D department and obtained. There was no conflict of interest.Results:The first phase of the study included 94 patients and showed that there were definite patterns for each shoulder disorder and it described colour-coded shoulder pain patterns according to the radiation of the pain around and beyond shoulder for six shoulder Levent Bayam @00279526disorders; acromioclavicular joint pathology, instability: Bankart’s, SLAP etc, calcific tendonitis, rotator cuff pathology, impingement syndrome, gleno-humeral joint arthritis. This showed a range from a very localised pain such as ACJ pathology to a very widespread pain such as GHJ arthritis. The second phase of the study included 194 patients and it tested the mapping patterns from the first phase. The accuracy for the first estimation for individual disorders was 45.4% and the overall accuracy for both estimations was 62.4. The sensitivity was high especially for instability and it was good for ACJ pathology and impingement syndrome. This phase clarified the pain patterns further and detailed three groups of pain patterns. The first group of diseases showed a localized pain around the shoulder and second group showed radiation of the pain beyond shoulder. Later, the second group was subdivided into two. Group 2A showed the pain radiation down to elbow level, whereas group 2B showed radiation below the elbow level. Third phase was to test inter-tester reliability of the maps by estimating the diagnoses derived from the maps by 3 raters. It tested the reliability for each disease group and individual disease. It showed a substantial agreement between the raters (Kappa (κ) = 0.71)Conclusion:A definitive pattern of pain distribution and specific types of pain were demonstrated for common shoulder pathologies. Testing the established maps indicated that the colourcoded maps were reliable and the algorithm was easy to understand. The study advocates the use of pain maps as an adjunctive diagnostic tool in general practice clinics and orthopaedic / shoulder clinics

Radial Oscillations of Neutron Stars in Strong Magnetic Fields

The eigen frequencies of radial pulsations of neutron stars are calculated in a strong magnetic field. At low densities we use the magnetic BPS equation of state(EOS) similar to that obtained by Lai and Shapiro while at high densities the EOS obtained from the relativistic nuclear mean field theory is taken and extended to include strong magnetic field. It is found that magnetised neutron stars support higher maximum mass where as the effect of magnetic field on radial stability for observed neutron star masses is minimal.Comment: latex2e file with five postscript figure

Bilateral radial neck fractures – A Case Report

Radial head and neck fractures are the most frequently seen elbow fractures. The usual cause of this injury is a fall onto an outstretched hand with a partly flexed elbow. We report here an unusual case of bilateral non-displaced radial neck fractures in a patient who presented with complaints of pain in both elbows following a simple fall. This case highlights the need for a high index of suspicion in the diagnosis of multiple injuries, no matter how `trivial` the mechanism of injury

Pain mapping for common shoulder disorders

We conducted a study to ascertain specific patterns of pain in patients with common shoulder disorders and to describe a comprehensive shoulder pain map. We prospectively studied 94 cases involving an upper limb pain map and correlated the maps with the final diagnoses made by 2 clinicians who were blinded to the pain map findings. Pattern, severity, and type of pain were specific to each common shoulder disorder. In subacromial impingement, pain was predominantly sharp, occurred around the anterior aspect of the shoulder, radiated down the arm, and was associated with dull, aching pain radiating to the hand. A similar pain pattern was found in rotator cuff tears. In acromioclavicular joint pathology, pain was sharp, stabbing, and well localized to the anterosuperior shoulder area. Glenohumeral joint arthritis was marked by the most severe pain, which occurred in a mixed pattern and affected the entire arm. Whereas the pain of instability was a mixture of sharp and dull pain, the pain of calcific tendonitis was severe and sharp. Both pains were limited to the upper arm and shoulder. Pain mapping revealed definitive patterns for shoulder pathologies. We advocate using pain maps as useful diagnostic guides and research tools

Evolution of the infirmary during the medieval; social, economic and religious status

The infirmary as we know it nowadays does not exist during the Middle Ages, but the various precursors of the modern hospital evolved as a result of interactions between East and West. There is hardly any research that describes the influence of the Medieval social, economic and religious status in the West and East on the infirmary. The present work aims on the development of the infirmary at Medieval time or Middle age with a short insight to previous evolution. The research was conducted in different stages. Textbooks and lectures from the Department of History and Methodology of Science of the University of Athens (UoA) and other relevant departments of Greek universities were consulted. In order to collect relevant information, the keywords “infirmary”, “medical theory”, “ antiquity”, “medieval”, “hospital”, “West” and “Asklipieion” were searched on Google, PubMed and Wikipedia. The infirmaries in the East were not simple buildings but rather a complex of clinical, teaching/education and praying areas. These institutions formed a model to the later European infirmaries. Many of the physicians of the East were ahead of their times. It is obvious that during the Middle Ages religion is a keystone for the function of the infirmary. Both in the East as in the West Christianity and Islam provide the ethical base and funding for the function and the development of new hospitals. Despite the conflict between these two worlds, their societies interacted and influenced medicine and the infirmary as an institution. It is the result of a long process of development of the relations between people, societies or even religions and the way humanity perceive its nature and the future. © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved