Background & Aims
Title: Sensory and motor profiles of the contralateral upper limb and neuroplastic changes in individuals with unilateral rotator cuff related shoulder pain – A systematic review
Rotator cuff related shoulder pain (RCRSP)constitutes 65 to 85% of shoulder conditions and have a significant impact on upper extremity function. One third of patients with RCRSP turn chronic and do not improve despite interventions to reverse motor impairments of the shoulder. Numerous studies have established bilateral alterations that underpin a reorganization of the central nervous system in individuals with unilateral chronic musculoskeletal pain. The evidence for sensory and motor profiles of the contralateral limb and neuroplastic (cortical) changes have not been specifically reviewed for RCRSP.
Objectives: To systematically assess, consolidate and appraise available evidence for sensory and motor attributes of the non-injured upper limb and neuroplastic changes in individuals with unilateral RCRSP.
Methods
Methods: A complete search of digital databases and reference lists was carried out to identify studies that evaluated sensory and motor measures of the involved and the uninvolved side in individuals with unilateral RCRSP. This review adhered to the Preferred Reporting Items for Systematic Reviews Meta-Analysis (PRISMA) statement and the recommendations outlined in the Meta-analysis and Systematic Review of Observational Studies in Epidemiology (MOOSE) framework. We included studies involving adult participants aged 18 and above, observational studies with a control group. Studies with no contralateral evaluation and a sample size of less than 10 were excluded. Two reviewers independently screened, appraised, and extracted the data using a customized data extraction tool. The findings from all the studies regardless of their methodological rigor were synthesized. The methodological quality of the included studies was evaluated using an adapted version of the Downs and Black Index.
Results
Results: The initial search of 5 databases, identified a total of 2243 studies. Following duplicate removal, 718 records were screened for titles and abstracts. Sixty- four full texts were screened for eligibility, out of which 35 satisfied the predefined inclusion criteria. Reasons for exclusion included lack of a healthy control group and studies involving experimental shoulder pain. Studies encompassed sensory measures (n=9) and motor measures (n=24), including cortical measures (n=2). Five out of 9 studies reported lower pressure pain thresholds and increased proprioceptive errors compared to the control group. Active trigger points were present bilaterally in individuals with RCRSP. Motor changes included reduced strength (n=7), altered kinematics of the scapula (n=3), and delayed muscle activity (n=4) compared to the pain- free control group. The methodological quality revealed high quality (n=10), moderate quality(n=23), and low quality (n=2) studies.
Conclusions
Conclusion: The available evidence indicates the presence of sensory and motor changes on the contralateral side in individuals with unilateral RCRSP. However, it is important to note the overall quality of evidence was moderate across the studies. Therefore, it is important that clinicians are aware of these changes on the uninjured side of patients with unilateral tendinopathies.
The findings of this review potentially hold significance for comprehending the pathophysiology and devising the management strategies for chronic RCRSP. Future research should include studies with larger sample sizes and must evaluate sensory and motor outcomes across different duration of RCRSP.
References
1. Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73–81.
2. Cadogan A, Laslett M, Hing WA, et al. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord. 2011 May 28;12(1):119.
3. Lewis JS. Rotator cuff tendinopathy. Br J Sports Med. 2009;43(4):236–241.
4. Cook T, Lewis J. Rotator cuff-related shoulder pain: to inject or not to inject? J Orthop Sports Phys Ther. 2019;49(5):289–293.
5. Ngomo S, Mercier C, Bouyer LJ, et al. Alterations in Central motor representation increase over time in individuals with rotator cuff tendinopathy. Clin Neurophysiol. 2015;126(2):365–371.
6. Bleichert S, Renaud G, MacDermid J, et al. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: a clinical commentary on assessment and management. J Hand Ther. 2017; 30(2):125–135.
7. Osborne JD, Gowda AL, Wiater B, et al. Rotator cuff rehabilitation: current theories and practice. Phys Sportsmed. 2016;44(1):85–92.
8. Alizadehkhaiyat O, Fisher AC, Kemp GJ, et al. Shoulder muscle activation and fatigue during a controlled forceful hand grip task. J Electromyogr Kinesiol. 2011;21(3):478–482.
9. MacDermid JC, Ramos J, Drosdowech D, et al. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg. 2004;13(6):593–598. 10.Gillespie MA, M Cznik A, Wassinger CA, et al. Rotator cuff-related pain: patients’ understanding and experiences. Musculoskelet Sci Pract. 2017;30: 64–71.
11. De Baets L, Matheve T, Meeus M, et al. The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019;33(6): 980–991.
12.Bachasson D, Singh A, Shah SB, et al. The role of the peripheral and Central nervous systems in rotator cuff disease. J Shoulder Elbow Surg. 2015;24(8): 1322–1335.
13.Nijs J, Roussel N, Paul van Wilgen C, et al. Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man Ther. 2013;18(2):96–102.
14.Lambers Heerspink FO, Dorrestijn O, van Raay JJ, et al. Specific patient-related prognostic factors for rotator cuff repair: a systematic review. J Shoulder Elbow Surg. 2014;23(7):1073–1080.
15.de Witte PB, van Adrichem RA, Selten JW, et al. Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis. Eur Radiol. 2016;26(10):3401–3411.
16.Woollard JD, Bost JE, Piva SR, et al. The ability of preoperative factors to predict patient-reported disability following surgery for rotator cuff pathology. Disabil Rehabil. 2017;39(20):2087–2096.
17.Tran G, Cowling P, Smith T, et al. What Imaging- Detected pathologies are associated with shoulder symptoms and their persistence? A systematic literature review. Arthritis Care Res (Hoboken)). 2018;70(8):1169–1184.
18.Rio E, Kidgell D, Moseley GL, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2016;50(4):209–215.
19.Roy JS, Bouyer LJ, Langevin P, et al. Beyond the joint: the role of Central nervous system reorganizations in chronic musculoskeletal disorders. J Orthop Sports Phys Ther. 2017;47(11):817–821. 20.Bisset LM, Russell T, Bradley S, et al. Bilateral sensorimotor abnormalities in unilateral lateral epicondylalgia. Arch Phys Med Rehabil. 2006;87(4): 490–495.
21.Littlewood C, Malliaras P, Bateman M, et al. The Central nervous system-an additional consideration in ’rotator cuff tendinopathy’ and a potential basis for understanding response to loaded therapeutic exercise. Man Ther. 2013;18(6):468–472.
22.Pelletier R, Higgins J, Bourbonnais D. Addressing neuroplastic changes in distributed areas of the nervous system associated with chronic musculoskeletal disorders. Phys Ther. 2015;95(11):1582–1591. 23.Pelletier R, Higgins J, Bourbonnais D. Is neuroplasticity in the Central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskelet Disord. 2015;16: 25.
24.Hannon J, Wang-Price S, Goto S, et al. Do muscle strength deficits of the uninvolved hip and knee exist in young athletes before anterior cruciate ligament reconstruction? Orthop J Sports Med. 2017; 5(1):232596711668394.
25.Andersson G, Forsgren S, Scott A, et al. Tenocyte hypercellularity and vascular proliferation in a rabbit model of tendinopathy: contralateral effects suggest the involvement of Central neuronal mechanisms. Br J Sports Med. 2011;45(5):399–406.
26.Miniaci A, Mascia AT, Salonen DC, et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002;30(1):66–73.
27.Heales LJ, Lim EC, Hodges PW, et al. Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability–implications for Central nervous system involvement: a systematic review with Meta-analysis. Br J Sports Med. 2014;48(19):1400–1406. 28.Plinsinga ML, Brink MS, Vicenzino B, et al. Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies: a systematic review. J Orthop Sports Phys Ther. 2015;45(11):864–875.
29.Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and Meta- analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647.
30.Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012.
31.Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
32.Moher D, Liberati A, Tetzlaff J, et al. PRISMA group. Preferred reporting items for systematic reviews and Meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
33.Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–384.
34.Arumugam A, Milosavljevic S, Woodley S, et al. Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine-a systematic review. Man Ther. 2012;17(4):275–284.
35.Tufanaru C, Munn Z, Stephenson M, et al. Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. Int J Evid Based Healthc. 2015;13(3):196–207.
36.Higgins JP. Commentary: heterogeneity in meta- analysis should be expected and appropriately quantified. Int J Epidemiol. 2008;37(5):1158–1160.
37.Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.
38.Papola D, Ostuzzi G, Thabane L, et al. Antipsychotic drug exposure and risk of fracture: a systematic review and meta-analysis of observational studies. Int Clin Psychopharmacol. 2018; 33(4):181–196.
Presenting Author
Kavitha Vishal
Poster Authors
Topics
- Models: Musculoskeletal