Rotator cuff tears: is non-surgical management effective?

This is an Accepted Manuscript of an article published by Taylor & Francis in Physical therapy Reviews on 28 December 2016, available online at: https://doi.org/10.1080/10833196.2016.1271504.Background: Rotator cuff-related shoulder pain is a common musculoskeletal complaint with an increasing number of people with shoulder pain undergoing surgical repair each year. The relationship between rotator cuff tendon tears and shoulder pain remains equivocal due to the high prevalence of tears in people without symptoms, which suggests that a proportion of people will undergo surgery on tissues not related to their symptoms. As a result there have been suggestions to initially manage atraumatic tears non-surgically. Objectives: The objective of this narrative review was to present current evidence regarding the assessment and management of full-thickness rotator cuff tears. Major findings: To date, three randomised controlled trials have compared surgical with non-surgical management of rotator cuff tears. Outcomes show a small but non-significant effect in favour of surgery. Only one study has looked at long-term outcomes of greater than one year. Overall 129 subjects have completed a course of non-surgical management and therefore low participant numbers may not be sufficient to draw firm conclusions. Conclusions: Current evidence currently supports the consideration of a non-surgical approach in the management of people with shoulder symptoms and identified rotator cuff tears, for a period of time.Peer reviewedFinal Accepted Versio

Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?

The current approach to musculoskeletal pain is failing The majority of persistent non-traumatic musculoskeletal pain disorders do not have a pathoanatomical diagnosis that adequately explains the individual’s pain experience and disability. We contend this has resulted in two concerning developments in the management of people with such disorders. First, structural changes observed on imaging that are highly prevalent in pain free populations, such as rotator cuff tears, intervertebral disc degeneration, labral tears and cartilage changes, are ascribed to individuals as a diagnosis for their condition. In this context, this information may result in the individual believing that their body is damaged, fragile and in need of protection, resulting in a cascade of movement and activity avoidance behaviours and seeking interventions to correct the structural deficits. This trend has led to exponential increases in elective surgery rates and associated costs, while the efficacy of repairing (eg, rotator cuff and medical meniscal tears), reshaping (eg, subacromial decompression) or replacing (eg, lumbar intervertebral discs) the structures considered to be at fault has been substantially challenged. Second, it is arguable that musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected (such as trigger points, sacral torsions), and they have developed and perpetuated treatment paradigms (such as ‘correcting’ upper body posture and muscle imbalances) that do not conform to current research evidence. These two trends have created an expectation that interventions (frequently ‘passive’) will provide a ’cure’, and typically quickly, with minimal self-contribution. This expectation may have been derived from a conversation with a friend or family member, from the Internet or from an advertising campaign, but almost certainly originated from health professionals.Peer reviewe

Constructing an understanding of mind : the development of children's social understanding within social interaction

Theories of children's developing understanding of mind tend to emphasize either individualistic processes of theory formation, maturation, or introspection, or the process of enculturation. However, such theories must be able to account for the accumulating evidence of the role of social interaction in the development of social understanding. We propose an alternative account, according to which the development of children's social understanding occurs within triadic interaction involving the child's experience of the world as well as communicative interaction with others about their experience and beliefs (Chapman 1991; 1999). It is through such triadic interaction that children gradually construct knowledge of the world as well as knowledge of other people. We contend that the extent and nature of the social interaction children experience will influence the development of children's social understanding. Increased opportunity to engage in cooperative social interaction and exposure to talk about mental states should facilitate the development of social understanding. We review evidence suggesting that children's understanding of mind develops gradually in the context of social interaction. Therefore, we need a theory of development in this area that accords a fundamental role to social interaction, yet does not assume that children simply adopt socially available knowledge but rather that children construct an understanding of mind within social interaction

Features of central sensitisation in patients with shoulder pain : A feasibility study

Design. A case-control feasibility study, comparing people with unilateral shoulder pain and pain free controls. Background. Previous studies have suggested that central sensitisation (CS) may be present in people with shoulder pain, mostly based on testing of nociception rather than mechanosensitivity, both of which can change as part of CS. Changes in mechanosensitivity are important for physiotherapy, which often involves non-noxious mechanoreceptor stimulation. Objectives. This study tested sensitivity to arangea range of mechanical stimuli potentially associated with CS in people with and without shoulder pain, compared to asymptomatic individuals. It was hypothesised that if CS was present, the response to mechanoreceptor stimulation would be increased. Methods. Both shoulders in both groups were tested for sensitivity of static and dynamic touch, vibration and punctate stimulation, plus temporal summation and pressure pain threshold (PPT). Participants completed a demographic questionnaire, pain scales, PainDETECT for neuropathic pain, and QuickDASH for upper limb function. Results. PPT was found to be significantly lower in the affected compared to the unaffected shoulders (p<0.003), but no other statistically significant between-group differences were found. Conclusion. This study found a lowered PPT in people with unilateral shoulder pain compared with asymptomatic individuals, but no evidence of a heightened response to other forms of mechanoreceptor stimulation. The study protocol was suitable for future studies and the required participant numbers were established. The variation in findings between studies suggests that a larger longitudinal study may be warranted .Peer reviewedFinal Published versio

Bloodletting for pneumonia, prolonged bed rest for low back pain, is subacromial decompression another clinical illusion?

This document is the Accepted Manuscript version of the following paper: Jeremy Lewis, 'Bloodletting for pneumonia, prolonged bed rest for low back pain, is subacromial decompression another clinical illusion?', British Journal of Sports Medicine, Editorial to Vol. 49 (5): 280-281, December 2014, doi: 10.1136/bjsports-2014-094367. Published by the BMJ Publishing Group Limited.Peer reviewedFinal Accepted Versio

Rotator cuff related shoulder pain: Assessment, management and uncertainties.

This document is the Accepted Manuscript version of the following article: Jeremy Lewis, ‘Rotator cuff related shoulder pain: Assessment, management and uncertainties’, Manual Therapy, Vol. 23: 57-68, June 2016, DOI: https://doi.org/10.1016/j.math.2016.03.009. This manuscript version is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Rotator cuff related shoulder pain (RCRSP) is an over-arching term that encompasses a spectrum of shoulder conditions including; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, and symptomatic partial and full thickness rotator cuff tears. For those diagnosed with RCRSP one aim of treatment is to achieve symptom free shoulder movement and function. Findings from published high quality research investigations suggest that a graduated and well-constructed exercise approach confers at least equivalent benefit as that derived from surgery for; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, partial thickness rotator cuff (RC) tears and atraumatic full thickness rotator cuff tears. However considerable deficits in our understanding of RCRSP persist. These include; (i) cause and source of symptoms, (ii) establishing a definitive diagnosis, (iii) establishing the epidemiology of symptomatic RCRSP, (iv) knowing which tissues or systems to target intervention, and (v) which interventions are most effective.Peer reviewedFinal Accepted Versio

Rotator Cuff related shoulder pain. Advances in understanding and management.

This document is the Accepted Manuscript version of the following paper: Jeremy Lewis, ‘Rotator Cuff related shoulder pain. Advances in understanding and management’, Journal of Science and Medicine in Sport, Vol. 20, Supp. 3, Nov 2017, page 47, DOI: https://doi.org/10.1016/j.jsams.2017.09.376. Under embargo. Embargo end date: 21 October 2018Peer reviewe

A randomised controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain

Study design Multicentre, double-blind, placebo-controlled randomised clinical trial. Objectives To compare the effectiveness of long chain omega-3 polyunsaturated fatty acids (PUFAs) as part of the management for people diagnosed with rotator cuff related shoulder pain (RCRSP). Summary of background Although there is no robust evidence to support their use, omega-3 PUFAs have been recommended for those with tendinopathy due to their potential to moderate inflammation. Methods Participants with RCRSP (n=73) were randomised to take either nine MaxEPA capsules providing 1.53 g eicosapentaenoic acid, 1.04 g docosahexaenoic acid or nine matching placebo capsules containing oleic acid per day for 8 weeks. In addition, participants attended an exercise/education programme for 8 weeks. Participants were assessed at prerandomisation, 8 weeks (primary outcome point), 3 months, 6 months and 12 months (secondary outcome point). Primary outcome was the Oxford Shoulder Score (OSS). Secondary outcomes included the Shoulder Pain and Disability Index (SPADI), Patient Specific Functional Score, Euro Qol 5D-3L, Short Form 36, global rating of change and impairment measurements. Analysis was by intention to treat. Results Difference in the change in the OSS between the two groups at 2 months was –0.1 (95% CI −2.6 to 2.5, p=0.95). The change in SPADI scores was −8.3 (95% CI −15.6 to −0.94, p=0.03, analysed by analysis of covariance adjusted for baseline) at 3 months. Conclusion Omega-3 PUFA supplementation may have a modest effect on disability and pain outcomes in RCRSP.Peer reviewedFinal Published versio

Enhancing Liquid And Gas Separation With Activated Carbon Mixed-Matrix Membranes

Mixed matrix membranes are one class of membrane material that are an especially promising separation media. By adding a particle phase to a matrix phase, multiple mechanistic pathways become available that are not present in pristine organic or inorganic membranes. These pathways can be exploited to better enhance separation performance for a variety of applications. This research has focused on a specific mixed matrix membrane, which contains bio-derived activated carbon particles in a polysulfone matrix. In proper selection of activating agent, this research has shown that the surface functional groups of the activated carbon are highly influenced. This can lead to better polymer filler interaction and fewer defects. This research has also provided evidence to support the idea that by changing various membrane formation parameters such as choice of solvent, nonsolvent, and additives, can influence many of the membrane’s thermal, physical, and separation properties. This work has shown the viability of biochar and activated carbon derived from biochar are fillers that are worth investigating in mixed matrix membranes. The membranes produced were shown to have versatile applications with modifications to formation process. The applications studied include liquid phase: acid blue filtration and gas phase: CO2/N2, CO2/CH4, and N2/CH4

The Lintheads\u27 Demise: A Study in Economic Dependency for the Piedmont Region of South Carolina

The decline of the Southern textile and apparel industries represent a unique and rich case study in rapid economic change. It is unique because of the speed and uniformity of collapse; rich, because of the geographic differences that exist even within the concentrated Piedmont textile cluster. Truly, globalization has hit this economic cluster with a brutal punch. And yet, not all cities and counties within the region have been equally harmed by the change. This report concentrates on examining the socioeconomic variations that have taken place in the thirteen foremost textile-producing counties in South Carolina since the collapse, as well as a sample dataset of forty-seven other Southern counties. The history of the industry is briefly traced in order to provide a background for the historical assumptions made in the analysis. A defined set of indicator factors are then compiled into an economic vigor score for each county, tracking both their socioeconomic change since the apogee of the textile industry and their current situation. This score is then regressed against their job dependency on the industry in 1960. The results indicate that historical hyper-dependency on textiles has no bearing on the health of Southern Piedmont counties, although a strong correlation does exist for the South Carolina data. Three factors are identified as having a positive effect on the changing industrial environment of counties, both urban and rural: distance from a regional metropolis, population, and a concerted effort at economic diversification. Relative economic performance of these counties has thus been lopsided, often depending on these three factors, providing both a warning and encouragement for economic development elsewhere