Exorotatie in de schouder belangrijk voor kwaliteit van leven perceptie

Op het Europese schouder en elleboog congres werd door middel van onderstaande voordracht duidelijk dat de exoroatie in de schouder (het van de buik af bewegen van de arm) een belangrijke functie is voor het dagelijkse functioneren en dat hier zelfs een relatie met de ervaren kwaliteit van leven aanwezig is. Deze beweging zorgt er onder andere voor dat de mond en de nek goed bereikt kunnen worden. Een dergelijke exorotatiebeperking komt vaak voor als eerste teken van een stijve of frozen shoulder. Niet alleen de pijn, maar zoals hier blijkt, ook de exorotatiebeperking van de schouder heeft dus een enorme impact op de kwaliteit van het leven.

Dit is zelfs onafhankelijk van de overall toestand van de schouder zoals die gemeten wordt met bijvoorbeeld de Constant score.

Dit wordt bevestigd door een andere voordracht op dit congres die verhaalt dat de meest gebruikte scores ter beoordeling van een schouder eigenlijk nauwelijks de problemen beoordelen die patienten aangeven. 

Correlation of shoulder external rotation strength with Constant Score and quality of life perception
J Miquel , G Vilà, F Santana, C Torrens (Barcelona - SPAIN)

Purpose

The objective of the study is to evaluate the correlation between the capacity to perform external rotation and quality of life perception (QLP) and if this correlation is affected by external rotation strength.

Material and Methods

Prospective study including 78 patients with a mean age of 59.96. There were 51 females and 27 males. 36 consulting because glenohumeral arthritis, 24 cuff disorders, 9 fractures and 9 instabilities. All patients completed SF-36 quality of life questionnaire and Constant Score. External rotation strength with the arm at the side (ER1) and with the arm at 90º of anterior elevation (ER2) was recorded with a digital strength tester.

Results

Ability to perform external rotation correlates with QLP (0,549 PF_norm, 0,418 RP_norm, 0,415 PHY comp), independently of total Constant Score. Increasing external rotation improves QLP.Strenght of external rotation correlates less than the ability to perform external rotation with QLP. Eventhough ER2 have a stronger correlation than ER1 (ER2 values on SF-36 : 0,467 PF_norm, 0,240 RP_norm, 0,381 PHY comp, while values for ER1 are : 0,326 PF_norm, 0,213 RP_norm, 0,326 PHY comp).

Discussion

There is a clear correlation external rotation and the QLP, and this correlation is independent of the total Constant Socre.The strenght of external rotation correlates less with QLP than the ability of external rotation. Strength at 90º of anterior elevation presents higher correlation than strenght with the arm at the side.
Muscular transpositions could improve QLP by restoring external rotation ability independent of the strength obtained.

Are problems in functioning reported in ICF Checklist by patients with shoulder pain represented in patient reported outcome measures?Y Roe , S Ostensjo, E Bautz-Holter, H Soberg (Oslo - NORWAY)

Purpose

The purpose was to identify the most common problems in functioning among individuals with shoulder pain, according to the ICF components body functions (b) and activities and participation (d), and to investigate whether these problems are represented in the content of three commonly used shoulder questionnaires.

Material and Methods

A cross-sectional study and a content linking procedure. Outpatients at a hospital were interviewed using an ICF Checklist. Presence of functional problems was registered. The frequency of cases with a problem was estimated for each category. The content of DASH, SPADI and ASES were trough a formal procedure linked to ICF categories. The linked content from the questionnaires were finally compared to the most frequently identified categories from the ICF Checklist interviews.

Results

165 participants, 54% women with a mean age of 46.5 years (SD = 12.5) were included. The five most frequently identified problems in the ICF body function component were : b280 Pain (98,8%), b710 Mobility of joint (90,9%), b134 Sleep (78,8%), b740 Muscle endurance functions (73,9%) and b130 Energy and drive functions (70,3%) The five most frequent in the activities and participation component were : d430 Lifting and carrying objects (84,8%), d850 Remunerative employment (78,8%), d920 Recreation and leisure (76,4%), d410 Changing basic body position (75,2%) and d510 Washing oneself (69,1%). None of the ICF categories b740, b130 and the d410 were present in the linked content from DASH, SPADI or ASES.

Conclusion

The results of this study show that some of the most frequent functional problems reported by individuals with shoulder pain are not covered by the content of three commonly used shoulder questionnaires.