Shoulder pain: paradox between the pathoanatomical model and clinical measurements

Introduction: The evaluation of patients with shoulder pain is highly influenced by pathoanatomical factors. Special tests and imaging are commonly used to the clinical decision-making. However, some studies have called this model into question suggesting more diversified evaluation systems such as movement-based and psychosocial aspects. Objectives: To verify the association of pathoanatomical factors with the symptom presentation and determine if pathoanatomical factors contribute to the self-reported shoulder function. Methods: Magnetic resonance imaging was used to evaluate in detail pathoanatomical abnormalities in individuals with unilateral shoulder pain. Images in the coronal, sagittal, and axial planes were generated and independently interpreted by a board-certified, orthopedic fellowship trained orthopedic shoulder surgeon and a musculoskeletal radiologist. Frequencies of pathoanatomical abnormalities for both shoulders were compared and the agreement across the evaluators was verified. In order to assess if pathoanatomical factors contributed to the self-reported shoulder function, a multivariate model was built considering the total score of the Disabilities of the Arm, Shoulder, and Hand (DASH) as the dependent variable. Clinical, demographics, pain catastrophizing, and special tests were used as explanatory variables. Results: Both shoulders presented a high prevalence of pathoanatomical abnormalities. Symptomatic shoulders showed the highest frequency of full-thickness tear and glenohumeral osteoarthrosis. Other observed pathoanatomical abnormalities did not show statistically significant differences between both shoulders. Pathoanatomical variables did not contribute to the multivariate model. The group of variables that best explained the selfreported shoulder function were pain intensity at rest, pain catastrophizing level, and acromioclavicular joint tenderness during palpation. Conclusions: Full-thickness rotator cuff tears and the presence of glenohumeral osteoarthrosis seem to be the only pathoanatomical abnormalities associated with the symptoms. Elevated pain catastrophizing levels and pain intensity at rest as well as acromioclavicular joint tenderness were the best explanatory variables to decreased self-reported shoulder function. Health professionals must be aware that most pathoanatomical abnormalities assessed with the magnetic resonance imaging are not related to the symptoms.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Introdução: A avaliação de pacientes com dor no ombro é altamente influenciada por fatores patoanatômicos. É comum a utilização de testes especiais ou de exames de imagem para a tomada de decisão clínica. Porém, esse modelo tem sido questionado por alguns estudos que sugerem avaliações baseadas em mecanismos diversos para o surgimento da dor como de alteração de movimento e aspectos psicossociais. Objetivos: Verificar a associação de fatores patoanatômicos com a apresentação de sintomas e determinar se fatores patoanatômicos contribuem para avaliação da função do ombro. Métodos: Ressonância nuclear magnética foi utilizada para avaliação detalhada de alterações patoanatômicas em indivíduos com dor unilateral de ombro. Cortes nos planos coronal, sagital e axial em sequências T1 e T2 foram produzidas e interpretadas de forma independente por um cirurgião ortopédico especializado em cirurgia de ombro e um radiologista especialista em ressonância com ênfase em musculoesquelética. As frequências de alterações patoanatômicas em ambos os ombros foram comparadas e a concordância entre os avaliadores foi avaliada. Para determinar se os fatores patoanatômicos contribuíram para a avaliação da função do ombro, um modelo multivariado utilizando a pontuação total do Disabilities of the Arm, Shoulder, and Hand (DASH) como variável dependente foi criado. Variáveis clínicas e demográficas, catastrofização da dor e testes especiais foram utilizados como variáveis explanatórias. Resultados: Ambos os ombros apresentaram alta prevalência de alterações patoanatômicas. Ombros sintomáticos apresentaram maior frequência de rupturas totais do manguito rotador e artrose glenoumeral. As demais alterações patoanatômicas observadas não demonstraram diferença estatisticamente significante entre os ombros. Variáveis patoanatômicas não contribuíram com o modelo multivariado. O conjunto de variáveis que melhor explicaram a função do ombro foram a intensidade da dor em repouso, nível de catastrofização e presença de dor à palpação na acromioclavicular. Conclusões: Rupturas totais de manguito rotador e presença de osteoartrose glenoumeral parecem ser as únicas alterações patoanatômicas associadas aos sintomas. Níveis elevados de catastrofização e dor em repouso assim como teste de cisalhamento da acromioclavicular positivo foram as melhores variáveis explanatórias para redução de função do ombro. Profissionais da saúde devem estar cientes que a maioria das alterações patoanatômicas avaliadas com a ressonância magnética não estão associadas com os sintomas.CAPES: 88881.062155/2014-0

The Brazilian version of the Constant-Murley Score (CMS-BR): convergent and construct validity, internal consistency, and unidimensionality

ABSTRACT OBJECTIVES: To translate and culturally adapt the CMS and assess the validity of the Brazilian version (CMS-BR). METHODS: The translation was carried out according to the back-translation method by four independent translators. The produced versions were synthesized through extensive analysis and by consensus of an expert committee, reaching a final version used for the cultural adaptation. A field test was conducted with 30 subjects in order to obtain semantic considerations. For the psychometric analyzes, the sample was increased to 110 participants who answered two instruments: CMS-BR and the Disabilities of the Arm, shoulder and Hand (DASH). The CMS-BR and DASH score range from 0 to 100 points. For the first, higher points reflect better function and for the latter, the inverse is true. The validity was verified by Pearson's correlation test, the unidimensionality by factorial analysis, and the internal consistency by Cronbach's alpha. RESULTS: The explained variance was 60.28% with factor loadings ranging from 0.60 to 0.91. The CMS-BR exhibited strong negative correlation with the DASH score (-0.82, p < 0.05), Cronbach's alpha 0.85, and its total score was strongly correlated with the patient's range of motion (0.93, p < 0.001). CONCLUSION: The CMS was satisfactorily adapted for Brazilian Portuguese and demonstrated evidence of validity that allows its use in this population

The Brazilian version of the Constant-Murley Score (CMS-BR): convergent and construct validity, internal consistency, and unidimensionality

ABSTRACT OBJECTIVES: To translate and culturally adapt the CMS and assess the validity of the Brazilian version (CMS-BR). METHODS: The translation was carried out according to the back-translation method by four independent translators. The produced versions were synthesized through extensive analysis and by consensus of an expert committee, reaching a final version used for the cultural adaptation. A field test was conducted with 30 subjects in order to obtain semantic considerations. For the psychometric analyzes, the sample was increased to 110 participants who answered two instruments: CMS-BR and the Disabilities of the Arm, shoulder and Hand (DASH). The CMS-BR and DASH score range from 0 to 100 points. For the first, higher points reflect better function and for the latter, the inverse is true. The validity was verified by Pearson's correlation test, the unidimensionality by factorial analysis, and the internal consistency by Cronbach's alpha. RESULTS: The explained variance was 60.28% with factor loadings ranging from 0.60 to 0.91. The CMS-BR exhibited strong negative correlation with the DASH score (-0.82, p < 0.05), Cronbach's alpha 0.85, and its total score was strongly correlated with the patient's range of motion (0.93, p < 0.001). CONCLUSION: The CMS was satisfactorily adapted for Brazilian Portuguese and demonstrated evidence of validity that allows its use in this population